Statin preloading may improve long-term PCI outcomes
MedWire News: High-dose rosuvastatin loading before percutaneous coronary intervention (PCI) is associated with improved clinical outcomes at 12 months, a study of patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) has found.
In a randomized clinical trial, rosuvastatin loading halved the risk for major adverse cardiac events (MACE) in patients with NSTE ACS who underwent an early invasive strategy.
The study was performed by Kyeong Ho Yun (Wonkwang University Hospital, Iksan, Republic of Korea) and colleagues with the aim of evaluating the long-term effects of statin pretreatment.
It is already known that statin loading before PCI is associated with a reduced risk for short-term adverse events and periprocedural myocardial infarction (MI) in ACS patients.
A total of 445 consecutive patients with NSTE ACS who had not previously received statin treatment were randomly assigned to receive rosuvastatin 40 mg or no statin treatment (control) before undergoing PCI.
All patients received aspirin 300 mg/day and clopidogrel 300 mg/day before the procedure, and glycoprotein IIb/IIIa inhibitors were used at the operator’s discretion. After PCI, all patients were prescribed aspirin 200 mg/day, clopidogrel 75 mg/day, and rosuvastatin 10 mg/day.
The average duration of follow-up was 11 months. During this time, MACE (defined as cardiac death, nonfatal MI, nonfatal stroke, and any ischemia-driven revascularization) occurred in 20.5% of patients in the control group compared with 9.8% in the rosuvastatin group, a statistically significant difference.
Kaplan-Meier curve analysis revealed that the rate of death/nonfatal MI was significantly higher in the control group than in the rosuvastatin group (hazard ratio=3.71).
Furthermore, multivariate analysis identified rosuvastatin loading as an independent predictor of a reduced risk for MACE at 12 months (odds ratio=0.5).
At 24 hours post-PCI, levels of C-reactive protein had risen significantly less in the rosuvastatin group than in the control group (4.6 vs 11.0 mg/l), indicating that rosuvastatin preloading “slowed the post-PCI inflammatory response,” say the researchers.
“High-dose rosuvastatin loading therapy before PCI significantly improved long-term clinical outcomes in patients with unstable angina and NSTEMI, possibly via inhibition of the periprocedural inflammatory response,” conclude Yun and co-authors in the International Journal of Cardiology.
“These results support the use of high-dose statin therapy before PCI in patients with ACS.”
However, the team notes that the trial was not originally intended to test the long-term benefits of high-dose statin loading and call for further study to confirm their results.
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By Joanna Lyford