Statin pretreatment improves CRP levels and myocardial perfusion in STEMI patients
MedWire News: Turkish researchers show that long-term statin pretreatment in patients with acute ST-segment elevation myocardial infarctions (STEMIs) is associated with lower C-reactive protein (CRP) levels on admission and better myocardial perfusion after primary percutaneous coronary intervention (PCI).
This leads to lower enzymatic infarct area and a more preserved left ventricular ejection fraction, they note.
"This is a group effect independent of lipid-lowering properties," Ayhan Erkol (Kartal Kosuyolu Heart Education and Research Hospital, Istanbul) and colleagues report in the American Journal of Cardiology.
The team retrospectively examined data (collected between January 2006 and April 2008) on 1617 patients with acute ST-segment elevation myocardial infarctions (STEMIs) who underwent primary PCI <12 hours after the onset of symptoms, to determine the impact of long-term statin treatment on the level of systemic inflammation and myocardial perfusion.
On admission, 19% (n=306) of the patients were receiving long-term statin treatment and the overall incidence of angiographic no-reflow, defined as postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade ≤2, was 12% (n=193).
Patients with no-reflow were significantly less likely to be receiving statin pretreatment than patients with reflow, at 6% versus 21%, respectively.
In patients with long-term statin pretreatment, baseline CRP levels and the frequency of angiographic no-reflow were significantly lower, compared with in patients not treated with statins (10 vs 15 mg/l and 3.9% vs 14%, respectively), and myocardial blush grade 3 was significantly more common (50% vs 40%).
Furthermore, the frequencies of complete ST-segment resolution and left ventricular ejection fraction were significantly higher in patients treated with statins compared with those who were not (70% vs 58% and 49 vs 46, respectively) and peak creatine kinase-MB was significantly lower (186 vs 241 IU/l).
"These results support the notion that statins may contribute to the maintenance of myocardial perfusion after primary PCI," explain Erkol and team.
They add that baseline CRP levels were a strong independent predictor of the no-reflow phenomenon, in addition to age ≥65 years, Killip class ≥2, lack of statin pretreatment, reperfusion time >4 hours, and preprocedural TIMI flow grade ≤1.
"[This] supports the idea that CRP is not only a marker of inflammation but also has a direct pathogenetic role in myocardial injury after myocardial infarction," conclude the researchers.
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By Nikki Withers