The effect of acute administration of statins on coronary microcirculation during the pre-revascularization period in patients with myocardial infraction.
The beneficial effects of statin pretreatment as well as of staccato reperfusion (SR) on myocardium have been demonstrated in patients undergoing cardiac interventions. In this study, we compared the effects of the acute statin administration prior to percutaneous coronary intervention (PCI) with the effects of staccato or abrupt reperfusion on coronary microcirculation in patients with myocardial infarction (MI).


METHODS
We randomly assigned 47 patients who had ST-elevation or non-ST-elevation MI 48 h prior to PCI, into three groups: staccato reperfusion (consisting of 6 periods of 10-s balloon inflation/deflation) plus statin therapy (SRSG), statin therapy plus abrupt reperfusion (SG), and abrupt reperfusion alone (ARG). Myocardial contrast echocardiography (MCE) was performed to assess the blood volume (A), velocity (β) and flow (A × β) of the segments associated with the PCI-treated artery the day following intervention and 30 days after. LV end-diastolic (EDV) and systolic volumes (ESVs), wall motion score index (WMSI) were evaluated.


RESULTS
Compared to ARG, SRSG and SG resulted in a greater improvement in A, β and A × β (F = 20.6, p < 0.001 for A, F = 3.5, p = 0.03 for β and F = 11.3, p < 0.001 for A × β for the overall effect of intervention) as well as a greater decrease of WMSI, EDV and ESV (p < 0.01) one month post-PCI. The changes of all echocardiography markers were greater in SRSG than SG (p < 0.01). The % changes in ESV correlated with the corresponding % changes in MCE indices in SRSG and SG (p < 0.05).


CONCLUSIONS
The acute statin administration prior to reperfusion either alone or in synergy with staccato reperfusion ameliorates coronary microcirculatory dysfunction in patients with myocardial infarction.
University of Athens, Second University Cardiology Department, Attikon Hospital, Greece.
Ioannis A
IA
Paraskevaidis
Efstathios K
EK
Iliodromitis
Ignatios
I
Ikonomidis
Loukianos
L
Rallidis
Eftihia
E
Hamodraka
John
J
Parissis
Aias
A
Andoniadis
Stavros
S
Tzortzis
Maria
M
Anastasiou-Nana
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D001783:Blood Flow Velocity / Q000187:drug effects; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003287:Contrast Media; D003326:Coronary Circulation / Q000187:drug effects*; D004452:Echocardiography; D005260:Female; D006115:Greece; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010743:Phospholipids; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000187:drug effects; D015607:Stents; D013318:Stroke Volume / Q000187:drug effects; D013459:Sulfur Hexafluoride; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride