Preloading with atorvastatin before percutaneous coronary intervention in statin-naive Asian patients with non-ST elevation acute coronary syndromes: A randomized study

Title
Preloading with atorvastatin before percutaneous coronary intervention in statin-naive Asian patients with non-ST elevation acute coronary syndromes: A randomized study
Author(s)
김영조장영수[장영수]junren zhu[junren zhu]junbo ge[junbo ge]chen ji[chen ji]william lam[william lam]
Keywords
MYOCARDIAL-INFARCTION; UNIVERSAL DEFINITION; ARTERY-DISEASE; CLINICAL-OUTCOMES; DOUBLE-BLIND; METAANALYSIS; THERAPY; PRETREATMENT; CHOLESTEROL; REDUCTION
Issue Date
201405
Publisher
ELSEVIER IRELAND LTD
Citation
JOURNAL OF CARDIOLOGY, v.63, no.5-6, pp.335 - 343
Abstract
Background: Data on atorvastatin pretreatment in Asian patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) are limited. However, there have been studies in other populations in Asia which demonstrated that statins can reduce the risk of periprocedural myocardial infarction (MI). Methods and results: Statin-naive patients with non-ST-segment-elevation (NSTE)-ACS scheduled for PCI were randomized to usual care or atorvastatin preloading groups. All patients received usual care including atorvastatin 40 mg/day. The atorvastatin group received atorvastatin 80 mg 12 h and 40 mg 2 h pre-PCI. Of 499 patients randomized, 247 were assigned to atorvastatin preloading. Following coronary angiography, 335 patients (163 atorvastatin) received Pa During the 30 days post-PCI, major adverse cardiac events (death, MI, and target vessel revascularization) occurred in 24 (15%) atorvastatin and 27 (16%) usual care patients (p = NS). Post hoc analyses showed that at 8 h post-PCI, 3.82% of the atorvastatin group and 7.22% of the usual care group had a post-procedural creatine kinase-myocardial band (CK-MB) above 3 times the upper limit of normal (p = 0.27) and at 24 h post-PCI, the rate was 7.64% versus 9.47% (p =1.0). Safety profile suggests that high-dose atorvastatin (40 mg) for up to 1 month, in conjunction with usual care, is relatively safe and well tolerated. Conclusions: This study of statin-naive Korean and Chinese patients with NSTE-ACS who received additional atorvastatin loading doses of 80 mg at 12h, and 40 mg at 2h, pre-PCI did not find a beneficial effect compared with usual post-PCI atorvastatin 40 mg/day treatment. Atorvastatin was found to be well tolerated in Asian patients with NSTE-ACS undergoing PCI. Results of the current study merit further investigation of the early use of statins in patients with NSTE-ACS to delineate patient subgroups who may benefit from this therapy. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
URI
http://hdl.handle.net/YU.REPOSITORY/32184http://dx.doi.org/10.1016/j.jjcc.2013.09.012
ISSN
0914-5087
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의과대학 > 내과학교실 > Articles
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