2016


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2016/№3

Loading doses of statins in elective endovascular interventions on coronary arteries

Vershinina E. O., Repin A. N., Salnikova E. S.
Federal State Budgetary Institution, “Research Institute of Cardiology” at the Siberian Branch of Russian Academy of Medical Sciences, Kievskaya 111a, Tomsk 63402

Keywords: IHD, stable angina, transcatheter coronary intervention, statins

DOI: 10.18087/rhj.2016.3.2181

Background. It is known that coronary endovascular interventions are followed by increased levels of cardiac biomarkers, which indicates cardiomyocyte necrosis. A possibility for prevention of perioperative myocardial necrosis with statins has been actively studied in recent years. Aim. To compare effects of loading doses of atorvastatin and rosuvastatin on acute myocardial injury and acute inflammatory response to the intervention, as evaluated by time-related changes in cardiac biomarkers (high-sensitivity troponin I (Tn I) and creatine kinase-MB fraction (CC–MB)), and high-sensitivity C-reactive protein (hsHRP), in elective endovascular interventions on coronary arteries. Materials and methods. This open, prospective, comparative study included 68 patients referred to an elective, transcutaneous coronary intervention (TCI) for obliterating coronary atherosclerosis. At baseline, all patients had been treated with statins for a long time as a part of standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of atorvastatin 80 mg 12 h prior to the intervention and then the same dose for 2–6 days. The second group included 35 patients treated with rosuvastatin 40 mg / day according to the same schedule. Levels of cardiac biomarkers, Tn I and CC–MB, were measured at baseline, 12, 24, 48, and 72 h of the intervention. The level of hsCRP was measured at baseline and at 5 days of the intervention. Results. The treatment with a loading dose of rosuvastatin was associated with significantly smaller increases in TnI and CC–MB (26.7 % and 27.1 %, respectively) during the first 12 h after the procedure; the number of patients with the postoperative TnI level >1 × UNL decreased by 24.3 %; and the number of patients with the postoperative CC–MB level >3 × UNL decreased by 12.1 %. The baseline levels of hsCRP were 1.65 (0.9–4) and 2.8 (0.8–6.8) mg / l in groups of atorvastatin and rosuvastatin loading dose, respectively (р=0.59). At 5 days of the intervention, the hsCRP level was significantly increased to 4.55 (1.6–8.7) mg / l (p=0.001) in the first group. In the second group, hsCRP not only did not increase but even somewhat decreased at 5 days of observation (2.75 (1.5–6.5) mg / l) (р=0.16). Conclusion. The loading dose of rosuvastatin exerted a better preventive effect on development of acute myocardial injury in TCI and greater decreased the general inflammatory response to the intervention compared with the loading dose of atorvastatin.
  1. Califf RM, Abdelmeguid AE, Kunitz RE, Popma JJ, Davidson CJ, Cohen EA et al. Myonecrosis after revascularization procedures. J Am Coll Cardiol. 1998 Feb;31 (2):241–51.
  2. Klein RW, Kramer BL, Howard E, Lesch M. Incidence and clinical significance of transient creatine kinase elevations and the diagnosis of non-Q wave myocardial infarction associated with coronary angioplasty. J Am Coll Cardiol. 1991 Mar 1;17 (3):621–6.
  3. Prasad A, Herrmann J. Myocardial infarction due to percutaneous coronary intervention. N Eng J Med. 2011 Feb 3;364 (5):453–64.
  4. Selvanayagam JB, Porto I, Channon K, Petersen SE, Francis JM, Neubauer S, Banning AP. Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging. Circulation. 2005 Mar 1;111 (8):1027–32.
  5. Ellis SG, Chew D, Chan A, Whitlow PL, Schneider JP, Topol EJ. Death following creatine kinase-MB elevation after coronary intervention. Identification of an early risk period: importance of creatine kinase-MB level, completeness of revascularization, ventricular function and probable benefit of statin therapy. Circulation. 2002 Sep 3;106 (10):1205–10.
  6. Ioannidis JP, Karvouni E, Katritis DG. Mortality risk conferred by small elevations of creatine-kinase MB isoenzyme after percutaneous coronary intervention. J Am Coll Cardiol. 2003 Oct 15;42 (8):1406–11.
  7. Chan AW, Bhatt DL, Chew DP, Quinn MJ, Moliterno DJ, Topol EJ, Ellis SG. Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention. Circulation. 2002 Feb 12;105 (6):691–6.
  8. Versaci F, Gaspardone A, Tomai F, Crea F, Chiariello L, Gioffre PA. Predictive value of C-reactive protein in patient with unstable angina pectoris undergoing coronary artery stent implantation. Am J Cardiol. 2000 Jan 1;85 (1):92–5.
  9. Hong YJ, Jeong MH, Lim SY, Lee SR, Kim KH, Sohn IS et al. Elevated preprocedural high-sensitivity C-reactive protein levels are associated with neointimal hyperplasia and restenosis development after successful coronary artery stenting. Circ J. 2005 Dec;69 (12):1477–83.
  10. Вершинина Е. О., Репин А. Н. Защита миокарда триметазидином при плановом эндоваскулярном лечении ишемической болезни сердца у пациентов с нарушениями углеводного обмена. Сердце. 2015;14 (4):187–92 [Vershinina E. O., Repin A. N. Zashhita miokarda trimetazidinom pri planovom e`ndovaskulyarnom leche­nii ishemicheskoj bolezni serdcza u paczientov s narusheniyami uglevodnogo obmena. Serdcze. 2015;14 (4):187–92].
  11. Merla R, Reddy NK, Wang FW, Uretsky BF, Barbagelata A, Birnbaum Y. Meta-analysis of published reports on the effect of statin treatment before percutaneous coronary intervention on periprocedural myonecrosis. Am J Cardiol. 2007 Sep 1;100 (5):770–6.
  12. Veselka J, Prochazkova S, Duchnova R, Homolova I, Tesar D, Bybee KA. Preprocedural statin therapy reduces the risk and extent of cardiac biomarkers release following percutaneous coronary intervention. Heart Vessels. 2006 May;21 (3):146–51.
  13. Jones SP, Trocha SD, Lefer DJ. Pretreatment with simvastatin attenuates myocardial dysfunction after ischemia and chronic reperfusion. Arterioscler Thromb Vasc Biol. 2001 Dec;21 (12):2059–64.
  14. Bell RM, Yellon DM. Atorvastatin, administered at the onset of reperfusion, and independent of lipid lowering, protects the myocardium by up-regulating a pro-survival pathway. J Am Coll Cardiol. 2003 Feb 5;41 (3):508–15.
  15. Mensah K, Mocanu MM, Yellon DM. Failure to protect the myocardium against ischemia / reperfusion injury after chronic atorvastatin treatment is recaptured by acute atorvastatin treatment: a potential role for phosphatase and tensin homolog deleted on chromosome ten? J Am Coll Cardiol. 2005 Apr 19;45 (8):1287–91.
  16. Wang T, Yang YJ, Xu B. Atorvastatin pretreatment before PCI accelerates both neointimal coverage and reendothelialization after sirolimus-eluting stent implantation using a porcine model: new fin­dings from optical coherence tomography and pathology. J Am Coll Cardiol. 2012;59:1196–1209.
  17. Школьникова М. А., Оганов Р. Г., Чазов И. Е. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков (второй пересмотр). Кардиоваскулярная терапия и профилактика. 2008;7 (6 S 4):1–37 [Shkol`nikova M. A., Oganov R. G., Chazov I. E. Diagnostika, lechenie i profilaktika arterial`noj gipertenzii u detej i podrostkov (vtoroj peresmotr). Kardiovaskulyarnaya terapiya i profilaktika. 2008;7 (6 S 4):1–37].
  18. Показания к реваскуляризации миокарда (Российский cогласительный документ). – М.: НЦССХ им. А. Н. Бакулева РАМН, 2011. – 162с [Pokazaniya k revaskulyarizaczii miokarda (Rossijskij coglasitel`ny`j dokument). – M.: NCzSSX im. A. N. Bakuleva RAMN, 2011. – 162s].
  19. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G. Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation. 2004 Aug 10;110 (6):674–8.
  20. Briguori C, Colombo A, Airoldi F, Violante A, Focaccio A, Balestrieri P et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction. Eur Heart J. 2004 Oct;25 (20):1822–8.
  21. Briguori C, Visconti G, Focaccio A, Golia B, Chieffo A, Castelli A et al. Novel Approches for Preventing or Limiting Events (NAPLES II) trial: impact of a single high dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol. 2009 Dec 1;54 (23):2157–63.
  22. Sardella G, Conti G, Donahue M, Mancone M, Canali E, De Carlo C et al. Rosuvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of myocardial periprocedural necrosis: the ROMA trial. Catheter Cardiovasc Interv. 2013 Jan 1;81 (1):E36–43.
  23. Patti G, Cannon CP, Murphy SA, Mega S, Pasceri V, Briguori C et al. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized study. Circulation. 2011 Apr 19;123 (15):1622–32.
  24. Di Sciascio G, Patti G, Pasceri V, Gaspardone A, Colonna G, Montinaro A. Efficacy of atorvastatin reload in patients on chro­nic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol. 2009 Aug 4;54 (6):558–65.
  25. Sardella G, Lucisano L, Mancone M, Conti G, Calcagno S, Stio RE et al. Comparison of high reloading ROsuvastatin and Atorvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of MyocArdial periprocedural necrosis. The ROMA II trial. Int J Cardiol. 2013 Oct 9;168 (4):3715–20.
  26. Zemanek D, Branny M, Martinkovicova L, Hajek P, Maly M, Tesar D et al. Effect of seven-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following percutaneous coronary intervention in patients receiving long-term statin therapy. A randomized study. Int J Cardiol. 2013 Oct 3;168 (3):2494–7.
  27. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Eur Heart J. 2007 Oct;28 (20):2525–38.
  28. Lim CC, van Gaal WJ, Testa L, Cuculi F, Arnold JR, Karamitsos T et al. With the «universal definition,» measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention. J Am Coll Cardiol. 2011 Feb 8;57 (6):653–61.
  29. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Eur Heart J. 2012 Oct;33 (20):2551–67.
  30. Davignon J. Beneficial cardiovascular pleiotropic effects of statins. Circulation. 2004 Jun 15;109 (23 Suppl 1):III39–43.
  31. Sanguigni V, Pignatelli P, Lenti L, Ferro D, Bellia A, Caraevale R et al. Short-term treatment with atorvastatin reduces platelet CD40 ligand and thrombin generation in hypercholesterolemic patients. Circulation. 2005 Feb 1;111 (4):412–9.
  32. Hinoi T, Matsuo S, Tadehara F, Tsujiyama S, Yamakido M. Acute effect of atorvastatin on coronary circulation measured by transthoracic Doppler echocardiography in patients without coronary artery disease by angiography. Am J Cardiol. 2005 Jul 1;96 (1):89–91.
  33. Angioi M, Abdelmouttaleb I, Rodriguez RM, Aimone-Gastin I, Adjalla C, Gueant JL, Danchin N. Increased C-reactive protein levels in patients with in-stent restenosis and its implications. Am J Cardiol. 2001 May 15;87 (10):1189–93.
  34. Gottsauner-Wolf M, Zasmeta G, Hornykewycz S, Nikfardjam M, Stepan E, Wexberg P et al. Plasma levels of C-reactive protein after coronary stent implantation. Eur Heart J. 2000 Jul;21 (14):1152–8.
  35. Dibra A, Mehilli J, Braun S, Hadamitzky M, Baum H, Dirschinger J et al. Inflammatory response after intervention assessed by serial C-reactive protein measurements correlates with restenosis in patients treated with coronary stenting. Am Heart J. 2005 Aug;150 (2):344–50.
  36. Orford JL, Selwyn AP, Ganz P, Popma JJ, Rogers C. The comparative pathobiology of atherosclerosis and restenosis. Am J Cardiol. 2000 Aug 24;86 (4B): 6H-11H.
Vershinina E. O., Repin A. N., Salnikova E. S. Loading doses of statins in elective
endovascular interventions on coronary arteries. Russian Heart Journal. 2016;15 (3):181–191

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