Reduction of No Reflow with a Loading Dose of Atorvastatin before Primary Angioplasty in Patients with Acute ST Myocardial Infarction
| Autor: | Leonor Serrano-Cuevas, Jose Alberto Ortega-Ramirez, Jesús Salvador Sánchez-Díaz, Jose Antonio Palomo-Villada, Eduardo Almeida-Gutiérrez, Irma Isordia-Salas, Rosalba Carolina García-Méndez, Martín Rosas-Peralta, Gabriela Borrayo-Sánchez, Rosa Marisol Alonso-Bravo |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Atorvastatin 030204 cardiovascular system & hematology Loading dose 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Reperfusion therapy Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Survival rate Aged business.industry Standard treatment Angioplasty Percutaneous coronary intervention General Medicine Middle Aged medicine.disease Survival Rate C-Reactive Protein Treatment Outcome Conventional PCI Cardiology No-Reflow Phenomenon ST Elevation Myocardial Infarction Female Hydroxymethylglutaryl-CoA Reductase Inhibitors business Preliminary Data medicine.drug |
| Zdroj: | Archives of Medical Research. 49:620-629 |
| ISSN: | 0188-4409 |
| DOI: | 10.1016/j.arcmed.2018.10.006 |
| Popis: | Background No reflow defined as an altered myocardial reperfusion and failure at microvascular level is a frequent complication in acute myocardial infarction that attenuates beneficial effect of reperfusion therapy leading to poor outcomes. There is not enough evidence to support that previous use of statins improves coronary flow in patients undergoing primary percutaneous coronary intervention (PCI). Aim of study To determine if a loading dose of 80 mg of atorvastatin before primary angioplasty reduces the frequency of no reflow, hs-CRP, IL6 intracoronary levels, and major combined cardiovascular events at 30 d. Methods In this controlled clinical trial, we randomly assigned 103 adult patients within the 12 h of acute ST-elevation myocardial infarction (STEMI) to receive 80 mg of atorvastatin additional to standard treatment (AST) before performing primary PCI versus standard treatment (ST) alone. The primary outcomes were the occurrence of no reflow and high sensitivity C-reactive protein (hs-CRP) and interleukin 6 levels and secondary outcomes were major adverse cardiovascular events at 30 d. Results 103 patients were analyzed, 49 (48%) received AST, 54 (52%) ST. Frequency of no reflow among groups was 27 vs. 63% respectively, p ≤0.0001. hs-CRP level was 2.69 mg/dL for AST vs. 2.2 mg/dL in ST, meanwhile IL-6 levels were 5.2 pg/mL vs. 6.35 pg/mL respectively, p = ns. Cox regression model demonstrated that the treatment assigned is an independent predictor for no reflow occurrence (HR 0.34 95%, CI 0.18–0.61, p ≤0.001). Conclusion The administration of a loading dose of 80 mg atorvastatin before primary PCI is an effective strategy for prevention of no reflow improving also clinical outcomes and free survival rate for the presentation of major adverse cardiovascular events at 30 d. |
| Databáze: | OpenAIRE |
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