Effect of High Dose Rosuvastatin Loading before Primary Percutaneous Coronary Intervention on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background and Objectives High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. Subjects and Methods A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. Results Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0±15.9% vs. 22.9±16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2±19.3 vs. 32.6±21.4, p=0.020), and higher MBG (2.49±0.76 vs. 2.23±0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. Conclusion A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.

Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy

“…Rosuvastatin loading therapy before PCI shows several beneficial effects, including reduced periprocedural myonecrosis, improved clinical outcome, and reduced infarct size 17)18)19). This statin also has beneficial clinical effects in patients with eGFR <60 mL/min/1.73 m 2 20).…”

Vascular and metabolic effects of ezetimibe combined with simvastatin in patients with hypercholesterolemia

“…With regard to beneficial effects of statins on endothelial dysfunction, all statins improve nitric oxide bioavailability resulting in improved flow-mediated dilator response to hyperemia (FMD) [5,6]. On the other hand, statins dose-dependently worsen insulin sensitivity [7].…”

Pre‐loading therapy with statins in patients with angina and acute coronary syndromes undergoing PCI

“…Additionally, MACE did not differ significantly among the groups . On the other hand, Kim et al examined the possible beneficial effect of rosuvastatin, a statin that had not previously been studied in the setting of STEMI and primary PCI . A total of 475 patients randomized to 40 mg rosuvastatin loading before primary PCI or no statin pretreatment.…”

“…Patients of the statin group showed a lower corrected TIMI frame count and higher myocardial blush grade. As a result, high dose rosuvastatin loading before the primary PCI seems to reduce the infarct size possible due to improvement of microvascular myocardial perfusion …”