Short-term high-dose atorvastatin for periprocedural myocardial infarction prevention in patients with renal dysfunction.
OBJECTIVE
Short-term high-dose atorvastatin administered before percutaneous coronary intervention (PCI) reduces the rate of periprocedural myocardial infarction (pMI) in high-risk patients, such as those with acute coronary syndromes and those with elevated high-sensitivity C-reactive protein. It is unknown whether short-term high-dose administration reduces the rate of pMI in patients with chronic kidney disease. Recently, we observed that in 304 patients with estimated creatinine clearance less than 60 ml/min randomized to receive 80 mg/day of atorvastatin or placebo for 48 h before elective coronary angiography and/or angioplasty, statin administration did not reduce contrast-induced nephropathy (CIN). In this post-hoc analysis, we evaluate the pMI in the subgroup of 161 patients who underwent PCI.


METHODS
In all patients, creatine kinase myocardial isoenzyme (CK-MB) [upper reference limit (URL) 5 ng/ml] was assessed before and at 12 and 24 h after PCI. The pMI, defined as CK-MB elevation more than three times the URL, occurred in 27 (17%) patients.


RESULTS
The incidence of pMI was 10.4% (of 77 patients) in the atorvastatin and 23% (of 84 patients) in the placebo group (P < 0.05). Multivariate analysis identified the pretreatment with high-dose atorvastatin as an independent predictor of reduced risk of pMI [odds ratio 0.39, 95% confidence interval 0.16-0.96, P < 0.05].


CONCLUSIONS
This post-hoc analysis shows that short-term high-dose atorvastatin administration reduced pMI in patients with renal dysfunction submitted to elective PCI, but without benefit regarding CIN prevention.
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. anna.toso@libero.it
Anna
A
Toso
Mario
M
Leoncini
Mauro
M
Maioli
Michela
M
Gallopin
Delio
D
Tedeschi
Marcello
M
Amato
Francesco
F
Bellandi
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005919:Glomerular Filtration Rate; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007558:Italy; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016017:Odds Ratio; D011758:Pyrroles / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D003404:Creatinine; D052279:Creatine Kinase, MB Form