Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

Herrmann, Joerg; Lerman, Amir; Baumgart, Dietrich; Volbracht, Lothar; Schulz, Rainer; Birgelen, Clemens von; Haude, Michael; Heusch, Gerd; Erbel, Raimund

doi:10.1161/01.cir.0000037520.89770.5e

Cited by 158 publications

(73 citation statements)

References 25 publications

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“…9 We expected an incidence of postprocedural CK-MB elevation of Ϸ30% in the placebo group and 10% in the treatment group. Thus, a sample size of 120 patients (with 60 in each group) would provide 80% power to detect a difference with an alpha (probability value) of 0.05.…”

Section: Discussionmentioning

confidence: 94%

Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention

et al. 2004

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on behalf of the ARMYDA Investigators Background-Small myocardial infarctions after percutaneous coronary intervention have been associated with higher risk of cardiac events during follow-up. Observational studies have suggested that statins may lower the risk of procedural myocardial injury. The aim of our study was to confirm this hypothesis in a randomized study. Methods and Results-One hundred fifty-three patients with chronic stable angina without previous statin treatment were enrolled in the study. Patients scheduled for elective coronary intervention were randomized to atorvastatin (40 mg/d, nϭ76) or placebo (nϭ77) 7 days before the procedure. Creatine kinase-MB, troponin I, and myoglobin levels were measured at baseline and at 8 and 24 hours after the procedure. Detection of markers of myocardial injury above the upper normal limit was significantly lower in the statin group versus the placebo group: 12% versus 35% for creatine kinase-MB (Pϭ0.001), 20% versus 48% for troponin I (Pϭ0.0004), and 22% versus 51% for myoglobin (Pϭ0.0005). Myocardial infarction by creatine kinase-MB determination was detected after coronary intervention in 5% of patients in the statin group and in 18% of those in the placebo group (Pϭ0.025). Postprocedural peak levels of creatine kinase-MB (2.9Ϯ3 versus 7.5Ϯ18 ng/mL, Pϭ0.007), troponin I (0.09Ϯ0.2 versus 0.47Ϯ1.3 ng/mL, Pϭ0.0008), and myoglobin (58Ϯ36 versus 81Ϯ49 ng/mL, Pϭ0.0002) were also significantly lower in the statin than in the placebo group. Conclusions-Pretreatment

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Section: Discussionmentioning

confidence: 94%

Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention

et al. 2004

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“…[23][24][25] Many studies have demonstrated that early statin therapy among PCI patients is associated with significant advantages for decreased mortality and morbidity in different patient subsets. 10,[26][27][28] Although the mechanism is not entirely clear, the anti-inflammatory effects of statins might contribute to the reduced myocardial injury during PCI. In the present study, prior statin therapy had no significant effect on postprocedural troponin elevation.…”

Section: Discussionmentioning

confidence: 99%

Changes of C-reactive Protein are Associated With Myocardial Injury After Successful Percutaneous Coronary Intervention

Rhee

Yun

et al. 2008

Korean Circ J

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Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. Subjects and Methods: We prospectively studied 231 patients (mean age: 62.8±10.6 years, males: 60.6%) who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. Blood samples for measuring the high sensitivity C-reactive protein (hsCRP) and troponin T (TnT) were obtained before the procedure and at 6 hours and 24 hours after PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hsCRP level and the preprocedural hsCRP level (delta CRP). We divided the patients according to the median value of delta CRP: Group I <2.2 mg/dL and Group II ≥2.2 mg/dL. Results: Postprocedural TnT elevation was were observed in 72 (31.2%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnT elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnT levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnT level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnT level 5 times the upper normal limit). Multivariate analysis revealed that postprocedural hsCRP elevation and complex lesion were the significant independent predictors of postprocedural TnT elevation. Conclusion: Elevated hsCRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury.

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“…44 In patients undergoing stenting of a de novo stenosis, the incidence of periprocedural myocardial injury, as assessed by analysis of creatine kinase and troponin T, was reduced by preprocedural treatment with HMG-CoA reductase inhibitors. 45 This beneficial effect is most likely attributable to antiinflammatory properties of HMG-CoA reductase inhibitors. 46 Thus, patients at risk of coronary microembolization may indeed benefit from acute antiinflammatory treatment with glucocorticoids.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid Treatment Prevents Progressive Myocardial Dysfunction Resulting From Experimental Coronary Microembolization

et al. 2004

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Background-The frequency and importance of microembolization in patients with acute coronary syndromes and during coronary interventions have recently been appreciated. Experimental microembolization induces immediate ischemic dysfunction, which recovers within minutes. Subsequently, progressive contractile dysfunction develops over several hours and is not associated with reduced regional myocardial blood flow (perfusion-contraction mismatch) but rather with a local inflammatory reaction. We have now studied the effect of antiinflammatory glucocorticoid treatment on this progressive contractile dysfunction. Methods and Results-Microembolization was induced by injecting microspheres (42-m diameter) into the left circumflex coronary artery. Anesthetized dogs were followed up for 8 hours and received placebo (nϭ7) or methylprednisolone 30 mg/kg IV either 30 minutes before (nϭ7) or 30 minutes after (nϭ5) microembolization. In addition, chronically instrumented dogs received either placebo (nϭ4) or methylprednisolone (nϭ4) 30 minutes after microembolization and were followed up for 1 week. In acute placebo dogs, posterior systolic wall thickening was decreased from 20.0Ϯ2.1% (meanϮSEM) at baseline to 5.8Ϯ0.6% at 8 hours after microembolization. Methylprednisolone prevented the progressive myocardial dysfunction. Increased leukocyte infiltration in the embolized myocardium was prevented only when methylprednisolone was given before microembolization. In chronic placebo dogs, progressive dysfunction recovered from 5.0Ϯ0.7% at 4 to 6 hours after microembolization back to baseline (19.1Ϯ1.6%) within 5 days. Again, methylprednisolone prevented the progressive myocardial dysfunction. Conclusions-Methylprednisolone, even when given after microembolization, prevents progressive contractile dysfunction.

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Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

Cited by 158 publications

References 25 publications

Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention

Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention

Changes of C-reactive Protein are Associated With Myocardial Injury After Successful Percutaneous Coronary Intervention

Glucocorticoid Treatment Prevents Progressive Myocardial Dysfunction Resulting From Experimental Coronary Microembolization

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