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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.
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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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