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Reduction of No Reflow with a Loading Dose of Atorvastatin before Primary Angioplasty in Patients with Acute ST
Rosalba C García-Méndez1, Eduardo Almeida-Gutierrez2, Leonor Serrano-Cuevas3
1División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Insights
Administering a high-dose atorvastatin loading dose before primary percutaneous coronary intervention significantly reduces no-reflow complications in acute myocardial infarction patients, improving outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- No-reflow phenomenon, characterized by impaired myocardial reperfusion, is a frequent complication of acute myocardial infarction (AMI).
- This microvascular dysfunction attenuates the benefits of reperfusion therapy and leads to poorer patient outcomes.
- Evidence regarding the efficacy of pre-treatment with statins to improve coronary flow during primary percutaneous coronary intervention (PCI) is limited.
Purpose of the Study:
- To evaluate the impact of an 80 mg atorvastatin loading dose prior to primary angioplasty on the incidence of no-reflow.
- To assess the effect of this intervention on intracoronary levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6).
- To determine the influence on major adverse cardiovascular events (MACE) at 30 days post-procedure.
Main Methods:
- A controlled clinical trial involving 103 adult patients with acute ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset.
- Patients were randomized to receive either 80 mg atorvastatin plus standard treatment (AST) or standard treatment (ST) alone before primary PCI.
- Primary endpoints included no-reflow occurrence, hs-CRP, and IL-6 levels; secondary endpoint was MACE at 30 days.
Main Results:
- The no-reflow frequency was significantly lower in the AST group (27%) compared to the ST group (63%) (p ≤0.0001).
- While hs-CRP and IL-6 levels showed non-significant differences between groups, Cox regression identified the assigned treatment as an independent predictor for no-reflow (HR 0.34, p ≤0.001).
Conclusions:
- Pre-procedural administration of an 80 mg atorvastatin loading dose is an effective strategy to prevent no-reflow during primary PCI.
- This approach improves clinical outcomes and enhances the event-free survival rate regarding major adverse cardiovascular events at 30 days.
Background:
No reflow defined as an altered myocardial reperfusion and failure at microvascular level is a frequent complication in acute myocardial infarction that attenuates beneficial effect of reperfusion therapy leading to poor outcomes. There is not enough evidence to support that previous use of statins improves coronary flow in patients undergoing primary percutaneous coronary intervention (PCI).
Aim Of Study:
To determine if a loading dose of 80 mg of atorvastatin before primary angioplasty reduces the frequency of no reflow, hs-CRP, IL6 intracoronary levels, and major combined cardiovascular events at 30 d.
Methods:
In this controlled clinical trial, we randomly assigned 103 adult patients within the 12 h of acute ST-elevation myocardial infarction (STEMI) to receive 80 mg of atorvastatin additional to standard treatment (AST) before performing primary PCI versus standard treatment (ST) alone. The primary outcomes were the occurrence of no reflow and high sensitivity C-reactive protein (hs-CRP) and interleukin 6 levels and secondary outcomes were major adverse cardiovascular events at 30 d.
Results:
103 patients were analyzed, 49 (48%) received AST, 54 (52%) ST. Frequency of no reflow among groups was 27 vs. 63% respectively, p ≤0.0001. hs-CRP level was 2.69 mg/dL for AST vs. 2.2 mg/dL in ST, meanwhile IL-6 levels were 5.2 pg/mL vs. 6.35 pg/mL respectively, p = ns. Cox regression model demonstrated that the treatment assigned is an independent predictor for no reflow occurrence (HR 0.34 95%, CI 0.18-0.61, p ≤0.001).
Conclusion:
The administration of a loading dose of 80 mg atorvastatin before primary PCI is an effective strategy for prevention of no reflow improving also clinical outcomes and free survival rate for the presentation of major adverse cardiovascular events at 30 d.
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