title: Aggressive statin therapy in multicenter and effectiveness for the reduction of intra-myocardial damage caused by non-ST elevation acute coronary syndrome: AMERICA study.
abstract: BACKGROUND
  While preprocedural statin treatment for acute coronary syndrome (ACS) is widely regarded as beneficial, there has been no prospective randomized multicenter trial of patients with non-ST elevation ACS in the Japanese population to examine the efficacy of preprocedural aggressive statin use. The aim of this study was to confirm this effect by prospective randomized multicenter design.
  
  
  METHODS
  Fifty patients who presented with non-ST elevation ACS were enrolled, and randomly assigned to aggressive statin administration before percutaneous coronary intervention (PCI). Troponin-T (TnT), creatine phosphokinase (CK), CK-myocardial band (CK-MB), high-sense C-reactive protein (hs-CRP), and brain natriuretic peptide (BNP) were measured at baseline and/ or after procedure.
  
  
  RESULTS
  Three days after PCI, the statin group had significantly less CK elevation compared with the nonstatin group (84+/-17 IU/l versus 180+/-68 IU/l, respectively, p = 0.02). CK-MB elevation also tended to be lower in the statin group than in the nonstatin group (3.2+/-1.9 versus. 7.0+/-3.0, respectively, p = 0.07), as was BNP level (3.2+/-1.9 versus 7.0+/-3.0 pg/ml, respectively, p = 0.07). The change of serum LDL cholesterol was significantly correlated with CK (p = 0.01) and TnT (p = 0.02) at 1 day after PCI.
  
  
  CONCLUSIONS
  Aggressive statin usage before PCI to Japanese patients with non-ST elevation ACS appears to reduce myocardial damage after procedure. The degree of serum lipid level reduction may reflect the vulnerability of atheromatous plaques that could cause cardiac damage after PCI.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. harahide@aol.com
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Itaru
authors.initials: I
authors.lastname: Yokouchi
authors.forename: Keiko
authors.initials: K
authors.lastname: Kimura
authors.forename: Naohiko
authors.initials: N
authors.lastname: Nemoto
authors.forename: Shingo
authors.initials: S
authors.lastname: Ito
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ono
authors.forename: Hideki
authors.initials: H
authors.lastname: Itaya
authors.forename: Masanori
authors.initials: M
authors.lastname: Shiba
authors.forename: Masamichi
authors.initials: M
authors.lastname: Wada
authors.forename: Raisuke
authors.initials: R
authors.lastname: Iijima
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Masato
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Hisao
authors.initials: H
authors.lastname: Hara
authors.forename: Takuro
authors.initials: T
authors.lastname: Takagi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Asahara
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Mitsuo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form