Pre-PCI Atorvastatin Reduces Cardiac Events

NEW ORLEANS — Two doses of atorvastatin before percutaneous coronary intervention reduced the 30-day risk of major adverse cardiac events by 88% among patients with acute coronary syndromes in a study presented at the annual meeting of the American College of Cardiology.

A composite primary end point consisting of death, myocardial infarction, or target vessel revascularization occurred in 4 (5%) of 86 patients who received preprocedural atorvastatin, a significant difference from the 14 (17%) of 85 of those assigned to placebo in the randomized, multicenter trial.

A multivariate analysis found an 88% risk reduction among patients pretreated with atorvastatin.

“This is a much greater effect than that observed in other large studies using a high dose of statins in acute coronary syndromes,” noted the investigators in an article timed for release during the meeting (J. Am. Coll. Cardiol. 2007;49:1272–8).

“Lipid-independent pleiotropic actions of atorvastatin may explain such effects,” Dr. Germano Di Sciascio of the department of cardiovascular sciences at Campus Bio-Medio University in Rome said at the meeting.

Dr. Di Sciascio and associates in the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) study group previously documented reduced MI during percutaneous coronary intervention (PCI) in stable angina patients pretreated with atorvastatin. They undertook the current study to determine whether patients with acute coronary syndromes would get the same benefits.

The trial enrolled 171 patients who had been referred for coronary angiography within 48 hours after presenting with unstable angina or non-ST-segment elevation acute MI.

Eligible subjects were randomly assigned to receive placebo or atorvastatin in an 80-mg loading dose given 12 hours before PCI and a 4-mg dose approximately 2 hours before the procedure. Otherwise, patients were treated according to standard protocols, receiving aspirin, clopidogrel, and intravenous heparin prior to the procedure; some patients also received glycoprotein IIb/IIIa inhibitors.

Procedures were performed at Campus Bio-Medico University of Rome; Vito Fazzi Hospital of Lecce, Italy; or University La Spienza of Rome.

Post procedure, all patients received daily aspirin and clopidogrel throughout the 30-day target period and were prescribed 40 mg/day of atorvastatin regardless of whether they received the drug or placebo before PCI.

Procedural success, defined as a reduction of stenosis to less than 30% of residual narrowing, was achieved in all patients, and no patient died in the ensuing 30 days.

The highly significant difference in incidence of major adverse cardiac events at 1 month was largely driven by postprocedural MI, which occurred in 4 (5%) of 86 patients receiving pre-PCI atorvastatin, compared with 13 (15%) of 85 on placebo. One patient in the placebo arm required target vessel revascularization.

“Our study shows 70% reduction in the incidence of periprocedural myocardial infarction: According to these data, 10 patients should be treated with atorvastatin to avoid one case of myocardial infarction,” they reported.

The investigators cautioned that the findings cannot be extrapolated to other patient groups.

Atorvastatin's 'lipid-independent pleiotropic actions' may account for its effects on the heart. DR. DI SCIASCIO

NEW ORLEANS — Two doses of atorvastatin before percutaneous coronary intervention reduced the 30-day risk of major adverse cardiac events by 88% among patients with acute coronary syndromes in a study presented at the annual meeting of the American College of Cardiology.

A composite primary end point consisting of death, myocardial infarction, or target vessel revascularization occurred in 4 (5%) of 86 patients who received preprocedural atorvastatin, a significant difference from the 14 (17%) of 85 of those assigned to placebo in the randomized, multicenter trial.

A multivariate analysis found an 88% risk reduction among patients pretreated with atorvastatin.

“This is a much greater effect than that observed in other large studies using a high dose of statins in acute coronary syndromes,” noted the investigators in an article timed for release during the meeting (J. Am. Coll. Cardiol. 2007;49:1272–8).

“Lipid-independent pleiotropic actions of atorvastatin may explain such effects,” Dr. Germano Di Sciascio of the department of cardiovascular sciences at Campus Bio-Medio University in Rome said at the meeting.

Dr. Di Sciascio and associates in the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) study group previously documented reduced MI during percutaneous coronary intervention (PCI) in stable angina patients pretreated with atorvastatin. They undertook the current study to determine whether patients with acute coronary syndromes would get the same benefits.

The trial enrolled 171 patients who had been referred for coronary angiography within 48 hours after presenting with unstable angina or non-ST-segment elevation acute MI.

Eligible subjects were randomly assigned to receive placebo or atorvastatin in an 80-mg loading dose given 12 hours before PCI and a 4-mg dose approximately 2 hours before the procedure. Otherwise, patients were treated according to standard protocols, receiving aspirin, clopidogrel, and intravenous heparin prior to the procedure; some patients also received glycoprotein IIb/IIIa inhibitors.

Procedures were performed at Campus Bio-Medico University of Rome; Vito Fazzi Hospital of Lecce, Italy; or University La Spienza of Rome.

Post procedure, all patients received daily aspirin and clopidogrel throughout the 30-day target period and were prescribed 40 mg/day of atorvastatin regardless of whether they received the drug or placebo before PCI.

Procedural success, defined as a reduction of stenosis to less than 30% of residual narrowing, was achieved in all patients, and no patient died in the ensuing 30 days.

The highly significant difference in incidence of major adverse cardiac events at 1 month was largely driven by postprocedural MI, which occurred in 4 (5%) of 86 patients receiving pre-PCI atorvastatin, compared with 13 (15%) of 85 on placebo. One patient in the placebo arm required target vessel revascularization.

“Our study shows 70% reduction in the incidence of periprocedural myocardial infarction: According to these data, 10 patients should be treated with atorvastatin to avoid one case of myocardial infarction,” they reported.

The investigators cautioned that the findings cannot be extrapolated to other patient groups.

Atorvastatin's 'lipid-independent pleiotropic actions' may account for its effects on the heart. DR. DI SCIASCIO

NEW ORLEANS — Two doses of atorvastatin before percutaneous coronary intervention reduced the 30-day risk of major adverse cardiac events by 88% among patients with acute coronary syndromes in a study presented at the annual meeting of the American College of Cardiology.

A composite primary end point consisting of death, myocardial infarction, or target vessel revascularization occurred in 4 (5%) of 86 patients who received preprocedural atorvastatin, a significant difference from the 14 (17%) of 85 of those assigned to placebo in the randomized, multicenter trial.

A multivariate analysis found an 88% risk reduction among patients pretreated with atorvastatin.

“This is a much greater effect than that observed in other large studies using a high dose of statins in acute coronary syndromes,” noted the investigators in an article timed for release during the meeting (J. Am. Coll. Cardiol. 2007;49:1272–8).

“Lipid-independent pleiotropic actions of atorvastatin may explain such effects,” Dr. Germano Di Sciascio of the department of cardiovascular sciences at Campus Bio-Medio University in Rome said at the meeting.

Dr. Di Sciascio and associates in the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) study group previously documented reduced MI during percutaneous coronary intervention (PCI) in stable angina patients pretreated with atorvastatin. They undertook the current study to determine whether patients with acute coronary syndromes would get the same benefits.

The trial enrolled 171 patients who had been referred for coronary angiography within 48 hours after presenting with unstable angina or non-ST-segment elevation acute MI.

Eligible subjects were randomly assigned to receive placebo or atorvastatin in an 80-mg loading dose given 12 hours before PCI and a 4-mg dose approximately 2 hours before the procedure. Otherwise, patients were treated according to standard protocols, receiving aspirin, clopidogrel, and intravenous heparin prior to the procedure; some patients also received glycoprotein IIb/IIIa inhibitors.

Procedures were performed at Campus Bio-Medico University of Rome; Vito Fazzi Hospital of Lecce, Italy; or University La Spienza of Rome.

Post procedure, all patients received daily aspirin and clopidogrel throughout the 30-day target period and were prescribed 40 mg/day of atorvastatin regardless of whether they received the drug or placebo before PCI.

Procedural success, defined as a reduction of stenosis to less than 30% of residual narrowing, was achieved in all patients, and no patient died in the ensuing 30 days.

The highly significant difference in incidence of major adverse cardiac events at 1 month was largely driven by postprocedural MI, which occurred in 4 (5%) of 86 patients receiving pre-PCI atorvastatin, compared with 13 (15%) of 85 on placebo. One patient in the placebo arm required target vessel revascularization.

“Our study shows 70% reduction in the incidence of periprocedural myocardial infarction: According to these data, 10 patients should be treated with atorvastatin to avoid one case of myocardial infarction,” they reported.

The investigators cautioned that the findings cannot be extrapolated to other patient groups.

Atorvastatin's 'lipid-independent pleiotropic actions' may account for its effects on the heart. DR. DI SCIASCIO