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A Randomized Trial of Creatine-kinase Leak After Rosuvastatin in Elective Percutaneous Coronary Intervention
Kleber B A Martins1, Luiz A P Mattos1, Amanda G M R Sousa2
1Instituto Dante Pazzanese de Cardiologia, Interventional Cardiology, Sao Paulo, Brazil.
Insights
High-dose rosuvastatin given before percutaneous coronary intervention (PCI) did not significantly reduce periprocedural myocardial infarction (PMI). This study found no significant difference in cardiac enzyme elevation between the rosuvastatin and control groups.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Prior research indicates high-dose statins may reduce periprocedural myocardial infarction (PMI) during percutaneous coronary intervention (PCI).
- Limited data exists on the impact of administering statins at peak concentration for elective PCI to prevent PMI.
Purpose of the Study:
- To evaluate the effect of a high loading dose of rosuvastatin, timed with peak concentration, on reducing periprocedural myocardial infarction (PMI) in patients undergoing elective percutaneous coronary intervention (PCI).
Main Methods:
- A prospective randomized trial involving 487 patients undergoing elective PCI.
- Patients were assigned to receive either a high loading dose of rosuvastatin before PCI or standard treatment.
- The primary outcome measured was the incidence of creatine kinase-MB (CK-MB) levels exceeding three times the upper limit of normal.
Main Results:
- The primary endpoint (CK-MB > 3x upper limit of normal) occurred in 7.6% of the rosuvastatin group versus 4.8% in the control group (P=0.200).
- No significant difference was observed in the elevation of CK-MB levels above baseline between the groups (67.1% vs 59.2%, P=0.701).
- Major adverse events were rare and similar between groups (0% vs 0.8%, P=0.370).
Conclusions:
- Administering a high loading dose of rosuvastatin timed with peak concentration before elective PCI did not significantly reduce the incidence of periprocedural myocardial infarction (PMI).
- Further research may be needed to explore optimal statin strategies for PMI prevention in PCI patients.
Objectives:
To determine the impact of percutaneous coronary intervention (PCI) performed at the same time of the peak concentration of rosuvastatin to reduce periprocedural myocardial infarction (PMI).
Background:
Prior studies suggest that a high dose of statin before PCI reduce periprocedural myocardial infarction. However, there is no information regarding the elective PCI performed at the time of the peak of statin concentration to reduce PMI.
Methods:
From 2001 to 2013, at a single center in Brazil we enrolled 544 patients who underwent elective PCI and after exclusions for baseline biases in clinical and angiographic characteristics, yielding 528 patients, we prospectively randomly assigned them to either a high loading dose of Rosuvastatin before PCI (n = 264) or standard treatment (n = 264). After exclusions for biases in procedural characteristics a total of 487 patients underwent to end points analysis. The primary outcome was the incidence of MB fraction of creatine kinase (CK-MB) greater than three times the upper limit of normal.
Results:
The primary end point occurred in 7.6% in the rosuvastatin and 4.8% in the control group (P = 0.200). There was a higher incidence in elevation of CK-MB than normal baseline in the rosuvastatin (67.1% vs 59.2%, P = 0.701). There was no difference in major adverse event (0% in the rosuvastatin group vs 0.8% in control).
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