[Prevention of periprocedural kidney ingury by loading doses of statins in elective percutaneous сoronary...

To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions.

An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg / day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI.

AKI was diagnosed in 5 patients (7.94 %): 4 patients (12.1 %) in group As and 1 patient (3.3 %) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4 % higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5 % higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng / ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16).

The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.