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Published on: May 28, 2019
Effect of high-intensity statin preloading on TIMI flow in patients presenting with ST-elevation myocardial
Ahmed Shawky Elserafy1, Nabil Mahmoud Farag2, Ahmed Ibrahim El Desoky2
1Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt. ahmedshawkyelserafy@gmail.com.
Insights
High-intensity statin therapy before primary percutaneous coronary intervention (PCI) significantly improved myocardial perfusion and ST-segment resolution in ST-elevation myocardial infarction (STEMI) patients. This pre-PCI statin approach enhances outcomes in acute myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Acute ST-elevation myocardial infarction (STEMI) remains a leading global cause of death and disability.
- Primary percutaneous coronary intervention (PCI) has improved STEMI outcomes, but further therapeutic advancements are needed for optimal myocardial reperfusion.
- Investigating the role of pre-procedural medical therapy, specifically high-intensity statins, is crucial for enhancing myocardial perfusion.
Purpose of the Study:
- To evaluate the impact of high-intensity statin administration prior to primary PCI on myocardial perfusion in acute STEMI patients.
- To assess the effect of pre-procedural high-intensity statins on post-PCI thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution.
Main Methods:
- A study involving 170 acute STEMI patients undergoing primary PCI at Ain Shams University Hospitals.
- Patients were randomized into two groups: one receiving high-intensity statins (atorvastatin 80mg or rosuvastatin 20mg) before PCI, and a control group receiving standard care with statins initiated post-PCI.
- Key outcome measures included post-interventional TIMI flow grade, MBG, and ST-segment resolution.
Main Results:
- The high-intensity statin group demonstrated statistically significant improvements in post-procedural TIMI flow grade (P=0.010) and myocardial blush grade (P=0.010) compared to the control group.
- Complete ST-segment resolution was significantly higher in the high-intensity statin group (40%) versus the control group (22.4%) (P=0.013).
- Ejection fraction was also significantly improved in the high-intensity statin group (45.91 ± 5.49) compared to the control group (43.01 ± 8.80) (P=0.011).
Conclusions:
- Pre-procedural high-intensity statin loading significantly enhances myocardial perfusion, as evidenced by improved TIMI flow and MBG post-primary PCI.
- The administration of high-intensity statins before primary PCI is associated with a greater likelihood of complete ST-segment resolution.
- High-intensity statin therapy prior to primary PCI positively impacts left ventricular ejection fraction in STEMI patients.
Background:
Acute ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (PCI) has improved the outcomes from STEMI and improved myocardial perfusion. However, there is still room for medical therapy to help perfuse the myocardium. The aim of this study was to assess the impact of high-intensity statins used prior to primary PCI in patients presenting with acute STEMI on myocardial perfusion. The study included 170 patients who presented with acute STEMI to Ain Shams University Hospitals and underwent primary percutaneous coronary intervention (PCI). They were divided into two groups where the first group received high-intensity statins (80 mg of atorvastatin or 20 mg of rosuvastatin) besides guideline-recommended therapy before primary PCI and the second group served as a control group and received guideline-recommended therapy, and high-intensity statins were given as usual after going back to the coronary care unit after primary PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded, and ST-segment resolution was measured.
Results:
The LAD was the culprit vessel for the majority of patients in both groups. In the control group, there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II, and 68 with TIMI III flow and MBG III. Meanwhile, in the cases group, there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II, and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs. 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction had values of mean ± SD of 45.91 ± 5.49 in the cases group vs. 43.01 ± 8.80 in the control group which was statistically significant with a P value of 0.011.
Conclusion:
High-intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution, and ejection fraction.
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