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Myocardial Infarct Size in Patients on Long-Term Statin Therapy Undergoing Primary Percutaneous Coronary Intervention

Giancarlo Marenzi1, Nicola Cosentino1, Sarah Cortinovis1

  • 1Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

The American Journal of Cardiology
|November 26, 2015
PubMed

Insights

Long-term statin therapy before primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients significantly reduces infarct size and improves myocardial salvage. This finding supports statin use for better outcomes in STEMI patients undergoing primary PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Imaging

Background:

  • Statin pretreatment may offer cardioprotection during percutaneous coronary intervention (PCI).
  • Evidence is controversial regarding statin effects in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI.
  • The impact of long-term statin therapy on infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) in STEMI requires further elucidation.

Purpose of the Study:

  • To prospectively evaluate the effect of long-term statin therapy on IS, MSI, and MVO in STEMI patients undergoing primary PCI.
  • To assess cardiac magnetic resonance imaging (CMR) parameters in STEMI patients with and without prior statin use.
  • To determine the association between previous statin therapy and infarct characteristics post-primary PCI.

Main Methods:

  • Prospective evaluation of 230 STEMI patients undergoing primary PCI.
  • Cardiac magnetic resonance (CMR) imaging performed during hospitalization (median 4 days post-PCI).
  • Measurement of peak troponin I, IS, MSI, and MVO using CMR; comparison between patients with and without long-term statin therapy.

Main Results:

  • Fifty patients (22%) were on long-term statin therapy.
  • Statin group showed significantly lower peak troponin I levels (p=0.02).
  • CMR revealed smaller IS (p=0.05) and higher MSI (p<0.01) in patients with prior statin use.
  • MVO was less frequent in the statin group (p=0.14).
  • Multivariate analysis confirmed statin therapy's association with smaller IS and higher MSI (p=0.05 and p=0.02, respectively).

Conclusions:

  • Long-term statin therapy before primary PCI in STEMI patients is associated with reduced infarct size.
  • Prior statin use correlates with improved myocardial salvage in STEMI patients undergoing primary PCI.
  • Further research is needed to confirm these findings and explore clinical implications.

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