Statins and their role in pre-percutaneous coronary intervention.
Lipid-lowering therapy with statins reduces the risk of cardiovascular events in patients with coronary artery disease. Recent in vitro and in vivo studies demonstrated a low-density lipoprotein-independent action of this class of drugs, which appears to modulate endothelial function, inflammation, and thrombosis. Randomized studies showed a beneficial effect of short-term statin pretreatment in reducing periprocedural cardiac marker release in patients undergoing percutaneous coronary intervention (PCI). In particular, the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) investigators--initially in stable angina patients, then in patients with acute coronary syndrome, and then in patients already on chronic statin therapy--demonstrated an improvement in 30-day major adverse cardiac event rates, which were driven by a reduced rate of periprocedural myocardial infarction. Moreover, statin therapy at the time of PCI significantly decreased the incidence of contrast-induced nephropathy. These observations support high-dose statin pretreatment in all patients who are candidates for PCI.
Melfi
Rosetta
R
Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy.
Nusca
Annunziata
A
Patti
Giuseppe
G
Di Sciascio
Germano
G
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D000787:Angina Pectoris / Q000188:drug therapy / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D003287:Contrast Media / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000139:chemically induced; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
D015415:Biomarkers; D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors