Short-term atorvastatin treatment improves intervention outcomes

A dose of atorvastatin, 80 mg, given 12 hours before angioplasty followed by a 40 mg dose administered 2 hours before the procedure reduces major cardiovascular events by 88% during the month after intervention, said Germano Di Sciascio, MD, during the American Academy of Cardiology’s 56th annual scientific session.

"Lipid-independent pleiotropic actions of atorvastatin may explain such rapid effects," said Dr. Di Sciascio, Campus Bio-Medico University of Rome, Italy. Since statins do not lower LDL cholesterol that quickly, it may be anti-inflammatory, antithrombotic, or vascular effects that improve outcomes.

The Atorvastatin for Reduction of Myocardial Damage during Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS) trial randomized 85 patients to receive the two doses of atorvastatin prior to angioplasty and 85 to receive placebo. All patients had unstable angina or a non-ST-segment elevation acute myocardial infarction (AMI) and were sent to angiography within 48 hours. Both groups were similar in terms of age, incidence of diabetes and hypertension, smoking status, and left ventricular ejection fraction.

None of the patients had previously taken a statin. All patients received aspirin and clopidogrel, 600 mg, before angioplasty and a majority of patients in both groups had been taking ACE inhibitors.

The primary end point was occurrence of death, MI, or need for revascularization at 30 days after angioplasty. Secondary end points were postprocedural increases of myocardial injury markers and variations from baseline in C-reactive protein (CRP).

Dr. Di Sciascio reported that after adjusting for patient variables, 17% of placebo patients versus only 5% of atorvastatin-treated patients met the primary endpoint, resulting in an 88% reduction in major cardiovascular events with atorvastatin pretreatment. "This was mostly driven by a 70% reduction in periprocedural MI in the atorvastatin group," he said.

The markers of cardiac injury, troponin-I and creatine kinase-MB, were significantly lower in the atorvastatin group compared with placebo when measured 30 days after intervention. In addition, while CRP levels did not significantly differ between the two groups at baseline, patients who were pretreated with atorvastatin had significantly lower CRP increases 30 days after the procedure (114% vs. 274%).

"Cardiologists should consider high-dose statins prior to interventional procedures," Dr. Di Sciascio said. "However, patients on current statin therapy were excluded by study design; it is unclear whether patients on chronic statin treatment may have a clinical benefit similar to that observed with acute administration."