title: Early high-dose rosuvastatin and cardioprotection in the protective effect of rosuvastatin and antiplatelet therapy on contrast-induced acute kidney injury and myocardial damage in patients with acute coronary syndrome (PRATO-ACS) study.
abstract: BACKGROUND
  There is a strong correlation between adverse clinical events and peak values of myocardial necrosis markers in non-ST-elevation acute coronary syndrome patients. In this clinical setting, high-dose statin treatment exerts acute beneficial effects against renal and myocardial damage. The aim of this report was to evaluate if, on admission, high-dose rosuvastatin can exert cardioprotective effects when administered in addition to high-dose clopidogrel.
  
  
  METHODS
  In the PRATO-ACS trial, 504 consecutive statin-naïve non-ST-elevation acute coronary syndrome patients scheduled for early invasive strategy and pretreated with high-dose clopidogrel were randomly assigned to rosuvastatin (40 mg on admission followed by 20 mg/d; statin group, n = 252) or no statin treatment (control group, n = 252). Serial myocardial biomarker samples were collected before and after angiography and/or percutaneous coronary intervention. The primary end point was the peak level of cardiac troponin I (cTnI) during the index event.
  
  
  RESULTS
  Statin-treated patients presented median cTnI peak values similar to controls (3.9 [0.6-12.8] vs 3.5 [1.2-11.9] ng/mL, respectively; P = .60]; no differences were found between the 2 groups in cTnI and creatine kinase-MB values at any time point, in either preangiography and postangiography peak values or their cumulative release. In patients submitted to percutaneous coronary intervention, periprocedural myocardial infarction occurred in 8 (4.7%) of 171 statin-treated and 7 (4.3%) of 162 control patients (P = .87).
  
  
  CONCLUSIONS
  In the PRATO-ACS trial, early high-dose rosuvastatin did not show cardioprotective effects when administered in addition to high-dose clopidogrel.
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Leoncini
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy. Electronic address: anna.toso@libero.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Toso
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tropeano
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy.
authors.forename: Toni
authors.initials: T
authors.lastname: Badia
authors.affiliation: Section of Biostatistics and Clinical Epidemiology, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Pavia University, Pavia, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Villani
authors.affiliation: Cardiology Division of Prato Hospital, Prato, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D000077144:Clopidogrel; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood; D005464:Fluorobenzenes / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D009336:Necrosis / Q000097:blood; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D019210:Troponin I; D000068718:Rosuvastatin Calcium; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form; D013988:Ticlopidine