title: Impact of long-term statin therapy on postprocedural myocardial infarction in patients undergoing nonemergency percutaneous coronary intervention.
abstract: Periprocedural statin therapy has been shown to decrease the rate of myocardial infarctions (MIs) after percutaneous coronary intervention (PCI). However, the impact of long-term statin therapy on postprocedure MI remains unknown. We examined the impact of long-term statin therapy on cardiac enzyme (cardiac troponin I [cTnI] and creatine kinase-MB [CK-MB]) increases after PCI in patients undergoing nonemergency PCI. Using the 2004/2005 Cornell Angioplasty Registry, we evaluated 1,482 patients undergoing elective or urgent PCI with normal preprocedure cardiac enzymes levels (cTnI and CK-MB). The population was divided into 2 groups: (1) patients on long-term (≥7 days) statin therapy before PCI (n = 1,073) and (2) patients not on long-term statin regimen (n = 409). Cardiac enzyme levels after PCI were assessed at 8, 12, and 18 hours after PCI. An increase in cTnI ≥1 time upper-limit of normal (ULN) was observed in 830 patients (56.1%) and an increase in cTnI ≥3 times ULN was observed in 518 patients (35.0%). There was no difference in incidence of cTnI increases ≥3 times ULN in patients on long-term statin therapy versus those not on long-term statin therapy in the overall group (35.1% vs 34.5%, p = 0.855). There was a trend toward a lower incidence of small cTnI increases ≥1 time ULN in patients on long-term statin therapy versus those not receiving long-term statins (54.6% vs 59.7%, p = 0.090). Incidence of CK-MB increases ≥1 time or ≥3 times ULN and peak cTnI and CK-MB levels were similar between the 2 groups. In a subgroup of patients with unstable angina, long-term statin therapy decreased small cTnI increases (≥1 time ULN) after PCI (54.6% vs 64.3%, p = 0.023). The greatest benefit in decrease of MIs after PCI was seen in patients with unstable angina receiving long-term high-dose statin therapy. In conclusion, long-term statin therapy did not decrease the incidence of periprocedural MI in patients with stable coronary artery disease undergoing nonemergency PCI. In patients with unstable coronary syndromes, long-term statin therapy may be beneficial, particularly at a high dose.
authors.affiliation: Greenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gordin
authors.forename: Ali
authors.initials: A
authors.lastname: Haider
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bergman
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019210:Troponin I; D052279:Creatine Kinase, MB Form