title: Administration of a loading dose of atorvastatin before percutaneous coronary intervention prevents inflammation and reduces myocardial injury in STEMI patients: a randomized clinical study.
abstract: BACKGROUND
  Administration of a loading dose of atorvastatin 80 mg/d has been shown to be beneficial in patients with stable coronary artery disease and acute coronary syndromes. However, little is known about the impact and mechanism behind the beneficial effects of loading-dose atorvastatin treatment before percutaneous coronary intervention (PCI), especially for those patients experiencing cardiovascular inflammation in ST-segment elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  The goal of this randomized clinical study was to investigate whether, before emergency PCI, administration of loading-dose atorvastatin therapy in STEMI patients inhibits inflammation and improves cardiac function during 24 weeks of follow-up.
  
  
  METHODS
  A total of 102 STEMI patients were enrolled into 3 groups: group A (n = 32) received 80 mg of atorvastatin before emergency PCI, post-PCI follow-up atorvastatin 40 mg for 4 weeks, and atorvastatin 20 mg for 20 weeks; group B (n = 32) received no pre-PCI loading dose of atorvastatin but did receive atorvastatin 40 mg for 4 weeks and then atorvastatin 20 mg for 20 weeks; and group C (n = 38) received only post-PCI atorvastatin 20 mg for 24 weeks.
  
  
  RESULTS
  No differences were found in baseline demographic and angiographic characteristics among the 3 groups. Patients in group A had the lowest plasma levels of high-sensitivity C-reactive protein (hs-CRP), B-type natriuretic peptide (BNP), and matrix metalloproteinase type 9 (MMP-9) (P < 0.05). Patients in group A also showed improvement in heart performance, with significant increases in their left ventricular ejection fraction. To a lesser extent, group B displayed reductions in the plasma levels of hs-CRP, BNP, and MMP-9 at later time points (P < 0.05). Compared with those in group C, patients in group B also exhibited significant improvement in left ventricular ejection fraction (P < 0.05).
  
  
  CONCLUSIONS
  Loading-dose atorvastatin therapy before emergency PCI reduced the inflammatory response and myocardial dysfunction in these STEMI patients by lowering hs-CRP, BNP, and MMP-9. Pre-PCI loading-dose atorvastatin treatment may help prevent inflammatory response and improve cardiac function in patients with acute coronary syndromes undergoing emergency PCI. ClinicalTrials.gov identifier: NCT01334671.
authors: Department of Cardiology, General Hospital of Chinese People's Armed Police Forces, Beijing, China.
authors: Hui-liang
authors: HL
authors: Liu
authors: Yong
authors: Y
authors: Yang
authors: Sheng-li
authors: SL
authors: Yang
authors: Jian-ping
authors: JP
authors: Luo
authors: Hong
authors: H
authors: Li
authors: Li-min
authors: LM
authors: Jing
authors: Zhi-qi
authors: ZQ
authors: Shen
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D002097:C-Reactive Protein / Q000378:metabolism; D003131:Combined Modality Therapy; D004452:Echocardiography; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000517:prevention & control*; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage* / Q000627:therapeutic use; D016277:Ventricular Function, Left
chemical_list: D006538:Heptanoic Acids; D011758:Pyrroles; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D000069059:Atorvastatin; D020780:Matrix Metalloproteinase 9