title: Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome?
abstract: OBJECTIVE
  There is controversy surrounding whether or not high dose statin administration before percutaneous coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing PCI.
  
  
  METHODS
  Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration 12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinase-myocardial band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI.
  
  
  RESULTS
  The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40 ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to 0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001).
  
  
  CONCLUSIONS
  Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an immediate anti-inflammatory effect in patients with NSTE-ACS.
authors.affiliation: Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea.
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.affiliation: Division of Cardiology, Inje University Ilsan-Paik Hospital, Goyang, Korea.
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Doh
authors.affiliation: Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea.
authors.forename: Byung-Ryul
authors.initials: BR
authors.lastname: Cho
authors.affiliation: Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
keywords: Acute coronary syndrome; Angioplasty; IMR; Microcirculation; Statins