Short-Term, High-Dose Atorvastatin Pretreatment to Prevent Contrast-Induced Nephropathy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention (from the ARMYDA-CIN [Atorvastatin for Reduction of MYocardial Damage during Angioplasty–Contrast-Induced Nephropathy] Trial

Patti, Giuseppe; Ricottini, Elisabetta; Nusca, Annunziata; Colonna, Giovanni; Pasceri, Vincenzo; D’Ambrosio, Andrea; Montinaro, Antonio; Sciascio, Germano Di

doi:10.1016/j.amjcard.2011.03.001

Cited by 178 publications

(150 citation statements)

References 29 publications

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“…For instance, in the Atorvastatin for Reduction of Myocardial Damage during Angioplasty-ContrastInduced Nephropathy (ARMyDACIN) study, the administration of a high dose of atorvastatin (80 mg 4 h before and 12 mg twelve hours after the procedure) reduced the incidence of CIN in the treatment group compared to the placebo group (5% vs. 13.2%, P=0.046) [31]. However, two important considerations must be made when comparing the results of the ARMyDACIN study with this analysis: 1) the patients included in the ARMyDACIN study were statin naïve; 2) and only included patients in acute coronary syndrome, in which are present an enhanced inflammatory profile and associated endothelial dysfunction, with the benefits from the anti-inflammatory and antioxidant effects of statin.…”

Section: Discussionmentioning

confidence: 99%

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Martins¹,

Oliveira²,

Mattos³

2017

Interventional-Cardiology.

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Background:Statins may reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). However, there is no knowledge that PCI performed at the same time of statin peak concentration in the blood, may cause additional benefit in renal protection. Methods:This study sought to determine whether PCI realized within the time of rosuvastatin peak concentration was associated with reduced in-hospital CIN compared with standard clinical practice. This single-center prospective, randomized, open-label, non-blinded clinical trial evaluated stable coronary artery disease patients taking chronic statin undergoing PCI. Patients were randomized to receive a loading dose of rosuvastatin (40 mg within 2 to 6 h before angioplasty) or to standard practice (without load dose of rosuvastatin). The pre-specified primary endpoint was the occurrence of CIN defined as an increase in the serum creatinine by {greater than or equal to} 0.3 mg/dl within 24 h after intervention. Contrast-induced nephropathy after coronary angioplasty by creatinine-kinase measure. This trial is registered with (Creatine Leak After Rosuvastatin in Percutaneous Coronary Intervention [CLEAR-PCI]; (ClinicalTrials.gov number: NCT01968577). Results:Of the 544 patients in the main trial, 528 participated in the CLEAR-CIN-PCI substudy, and 493 patients (244 in the rosuvastatin group and 249 in control) were analyzed. CIN occurred in 6 patients of the 244 patients (2.5%) treated with rosuvastatin compared with 9 of the 249 patients (3.6%) in control group (risk ratio, 0.80; 95% confidence interval [CI], 0.42 to 1.50; P=0.455). Conclusion:This result does not support the initiation of rosuvastatin before elective PCI to prevent CIN in patients taking chronic statin therapy.

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Section: Discussionmentioning

confidence: 99%

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Martins¹,

Oliveira²,

Mattos³

2017

Interventional-Cardiology.

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“…8 However, two important considerations must be made when comparing the results of the ARMyDACIN study with this analysis: 1) the patients included in the ARMyDACIN study were not receiving any statins, 2) the study only included patients experiencing an acute coronary syndrome. In contrast, the population of the present study was already receiving chronic statin treatment and was, therefore, experiencing the pleiotropic effects of this agent.…”

Section: Discussionmentioning

confidence: 99%

“…Statins may act during these stages to downregulate the angiotensin receptor, decrease endothelin synthesis, increase nitric oxide bioavailability, decrease the expression of endothelial adhesion molecules, limit the production of oxygen reactive species, and protect against complement-mediated injury. 8 A booster dose of rosuvastatin was administered two to six hours before the procedure to ensure that tissues were exposed to contrast medium during the peak serum concentration of rosuvastatin, which occurs approximately five hours after administration. Some anti-inflammatory effects were detected in the first 24 hours after the administration of a single 40 mg dose of pravastatin.…”

Section: Discussionmentioning

confidence: 99%

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Impacto na função renal de uma dose de reforço de rosuvastatina prévia a intervenção coronária percutânea eletiva nos pacientes em uso crônico de estatina

Oliveira¹,

Martins

Costa³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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AbStRACtbackground: Contrast-induced nephropathy (CIN) is a potential complication after percutaneous coronary intervention (PCI). The pathogenesis of this complication has been linked to inflammation, endothelial dysfunction and oxidative stress. In this study, statins were investigated as a treatment for CIN because of the pleiotropic effects of these drugs, assessing whether a preload dose of rosuvastatin prior to elective PCI in patients receiving chronic statin treatment reduced the incidence of CIN. Methods: This study was designed as a prospective, randomised, open label, single -centre study. The patients were grouped based on the inclusion (group 1) or exclusion (group 2) of 40 mg rosuvastatin treatment two to six hours prior to PCI. The frequency of CIN in these two groups, as well as the diabetic and renal dysfunction subgroups, was compared. Results: The study comprised 135 patients aged 60.7 ± 9.3 years who were randomised to group 1 (n = 67) or group 2 (n = 68). The overall prevalence of diabetes was 31.1%, and the overall prevalence of a creatinine clearance rate < 60 mL/min was 13.3%. The overall incidence of CIN was 8.1%, with no difference between groups (9% vs. 7.4%; P = 0.89). The incidence of CIN was 15% vs. 13.6% in the diabetic patients (P = 0.75), and 12.5% vs. 0% in those

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“…A number of retrospective and prospective studies have demonstrated the potential protective effect of statins on CIN (9)(10)(11). In addition, statins have been reported to exhibit antioxidant effects through decreasing the mRNA expression of NOX4 and p22phox (12,13).…”

Section: Introductionmentioning

confidence: 99%

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells

Liu

Lei

Duan

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Contrast media (CM)-induced nephropathy (CIN) is a serious complication of intravascularly applied radiocontrast media. At present, no drugs have been approved for the prevention of CIN. The present study aimed to explore the effects and potential mechanisms of atorvastatin on iodinated CM-induced cytotoxicity in the human proximal renal tubular epithelial cells. The cytotoxic effect of iohexol (50, 100 and 200 mg I/ ml) and the protective effect of atorvastatin pretreatment (1, 20 and 40 µM) were assessed. The cytotoxicity of iohexol was evaluated via the MTT cell viability and lactate dehydrogenase assays. The amount of apoptotic cells was determined by flow cytometry. Morphological changes in HK-2 cells were observed via transmission electron microscopy. The mRNA expression of NOX4 and p22phox was measured through reverse transcription-quantitative polymerase chain reaction analysis. The cytotoxicity was induced by iohexol in HK-2 cells. Atorvastatin was identified to significantly alleviate the suppression of cell viability induced by iohexol. Notably, 40 µM atorvastatin also significantly reduced the mRNA expression of intracellular NOX4 and p22phox, and the percentage of apoptotic cells. Furthermore, morphological changes characteristic of injured cells were alleviated by atorvastatin pretreatment. These results suggest that atorvastatin exhibits a protective effect on HK-2 cells against iohexol-induced cytotoxicity through the downregulation of NOX4 and p22phox. Thus, atorvastatin is a potential therapeutic agent for the prevention of CIN and required further study.

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Cited by 178 publications

References 29 publications

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study

Impacto na função renal de uma dose de reforço de rosuvastatina prévia a intervenção coronária percutânea eletiva nos pacientes em uso crônico de estatina

Atorvastatin alleviates iodinated contrast media-induced cytotoxicity in human proximal renal tubular epithelial cells

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