Effects of pretreatment with statins on infarct size in patients with acute myocardial infarction who receive fibrinolytic therapy.
BACKGROUND
Experimental studies suggest that statins promote vascular fibrinolysis, so statin treatment before the onset of acute myocardial infarction (AMI) may result in a smaller infarct size.


RESULTS
The study group comprised 310 patients with AMI who received fibrinolysis within 12 h after symptom onset: 39 had received statin pretreatment (statin group) and 271 had not (non-statin group). Initial Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ between groups. Among 120 patients with initial TIMI flow grade 0/1, achievement of TIMI flow grade > or =2 after passing the guidewire through the culprit lesion was more frequent in the statin group (70% vs 35%, P=0.03). The final rate of TIMI flow grade 3 was higher in the statin group (95% vs 86%, P=0.11). Area under the curve (AUC) for creatine kinase (CK) was lower in the statin group (55,972+/-45,934 vs 84,195+/-84,276 IU . L(-1) . h(-1), P=0.04). Multivariate analysis revealed statin pretreatment as an independent negative predictor of larger infarct size as defined by the upper tertile of AUC for CK (odds ratio 0.25, 95% confidence interval 0.07-0.91, P=0.035).


CONCLUSIONS
Statin pretreatment may enhance fibrinolysis and reduce infarct size in patients with AMI.
Kiyokuni
Masayoshi
M
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Kosuge
Masami
M
Ebina
Toshiaki
T
Hibi
Kiyoshi
K
Tsukahara
Kengo
K
Okuda
Jun
J
Iwahashi
Noriaki
N
Maejima
Nobuhiko
N
Kusama
Ikuyoshi
I
Komura
Naohiro
N
Nakayama
Naoki
N
Umemura
Satoshi
S
Kimura
Kazuo
K
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology*; D016017:Odds Ratio; D015427:Reperfusion Injury / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D015912:Thrombolytic Therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003402:Creatine Kinase; D001241:Aspirin