Copyright © 2004 by the European Society of Cardiology.
Clinical research
Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction
a Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio 2, I-80121 Naples, Italy
b Laboratory of Interventional Cardiology, "Vita e Salute" University School of Medicine, San Raffaele Hospital, Milan, Italy
c Institute of Medical Statistics and Biometry, University of Milan, Milan, Italy
Received March 11, 2004; revised May 6, 2004; accepted July 15, 2004 * Corresponding author. Tel.: +39 81 7259 764; fax: +39 81 7259 724 (E-mail: briguori.carlo{at}hsr.it).
AIMS: Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI.
METHODS AND RESULTS: Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure.Incidence of peri-procedural myocardial injury was assessed by analysis of creatinine kinase myocardial isoenzyme (CK-MB: upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (cTn I, ULN 0.10 ng/ml) before, 6 and 12 h after the intervention. A large non-Q-wave myocardial infarction was defined as a CK-MB elevation >5 times ULN alone or associated with chest pain or ST segment or T wave abnormalities.
Median CK-MB peak after PCI was 1.70 (interquartile ranges 1.10–3.70) ng/ml in the Statin group and 2.20 (1.30–5.60) ng/ml in the Control group (p=0.015). Median peak of cTnI after PCI was 0.13 (0.05–0.45) ng/ml in the Statin group and 0.21 (0.06–0.85) ng/ml in the Control group (p=0.033). The incidence of a large non-Q-wave myocardial infarction was 8.0% in the Statin group and 15.6% in the Control group (p=0.012: OR=0.47; 95% CI=0.26–0.86). The incidence of cTnI elevation >5 times ULN was 23.5% in the Statin group and 32% in the Control group (p=0.043: OR=0.65; 95% CI=0.42–0.98). By logistic regression analysis, the independent predictors of CK-MB elevation >5 times ULN after PCI were intra-procedural angiographic complications (OR=9.36; 95% CI=3.06–28.64; p<0.001), statin pre-treatment (OR=0.33; 95% CI=0.13–0.86; p=0.023) and age >65 years (OR=2.58; 95% CI=1.09–6.11; p=0.031).
CONCLUSIONS: Pre-procedural statin therapy reduces the incidence of large non-Q-wave myocardial infarction after PCI.
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