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

Abstract

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

Beneficial Effects of High-Dose Atorvastatin Pretreatment on Renal Function in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention

“…Short-term statin pretreatment has improved clinical outcome through lipid-lowering independent pleiotropic effects in various clinical settings, such as in the prevention of periprocedural myocardial damage during PCI [4,7,8,9] or the decrease of postoperative atrial fibrillation after cardiac surgery [5], possibly via anti-inflammatory effects [4]. Inflammatory mechanisms and oxidative stress may also be involved in the pathogenesis of CIN [10,11].…”

Effect of Intensive Atorvastatin Therapy on Periprocedural PDCD4 Expression in CD4+ T Lymphocytes of Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

“…The ARMYDA study revealed that the average percent increase in CRP levels from baseline was significantly lower in the intensive atorvastatin treatment arm [2], and intensive atorvastatin treatment significantly reduced the release of myocardial damage markers detected following coronary intervention, including myoglobin, cTnI and CK-MB [3]. Our results found that intensive atorvastatin treatment (80 mg/day) 48 h before PCI can significantly reduce the incidence of elevated cTnI post-PCI, showing that intensive atorvastatin pretreatment can reduce the incidence of PMI.…”

“…One such therapy involves hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) which can be administered in a loading dose prior to PCI. In the Atorvastatin for Reduction of Myocardial Damage during Angioplasty (ARMYDA) trial, the first randomized, double-blind, placebo-controlled trial to analyze the effect of pretreatment with a loading dose of statin prior to PCI, administration of 80 mg of atorvastatin 12 h prior to the procedure with a further 40-mg preprocedure dose or 40 mg of atorvastatin pretreatment was found to significantly decrease the occurrence of periprocedural myocardial infarction [2,3,4,5]. It also decreased the 30-day incidence of major adverse cardiac events.…”

Atorvastatin — 20 Years in the Struggle for Life

“…Исследование ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) [64] стало одним из первых исследований, в которых оценива-лась эффективность статинов, а именно аторваста-тина, на риск развития периоперационного ИМ -перипроцедурного прогностически неблагоприят-ного осложнения [65]. В исследование было включено 153 пациента со стабильной ИБС, не принимавших статины, и с планируемым ЧКВ.…”

“…Частота больших кардиоваскулярных событий в тече-ние 1 мес. наблюдения также была достоверно ниже в группе аторвастатина по сравнению с группой пла-цебо: 5% и 18%, соответственно, (р=0,025) [64].…”