Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the STATIN STEMI trial

• Published in: JACC. Cardiovascular interventions 2010-03, Vol.3 (3), p.332-339
• Main Authors: Kim, Jung-Sun, Kim, Jaedeok, Choi, Donghoon, Lee, Chan Joo, Lee, Sang Hak, Ko, Young-Guk, Hong, Myeong-Ki, Kim, Byoung-Keuk, Oh, Seong Jin, Jeon, Dong Woon, Yang, Joo-Young, Cho, Jung Rae, Lee, Nam-Ho, Cho, Yun-Hyeong, Cho, Deok-Kyu, Jang, Yangsoo
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; Atorvastatin Calcium; Chi-Square Distribution; Coronary Angiography; Coronary Circulation - drug effects; Disease-Free Survival; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Heptanoic Acids - administration & dosage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Kaplan-Meier Estimate; Korea; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Pyrroles - administration & dosage; Recurrence; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Time Factors; Treatment Outcome
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2009.11.021

This study sought to determine the efficacy of high-dose atorvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Previous randomized trials have demonstrated that statin pre-treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, no randomized studies have been carried out with STEMI patients in a primary PCI setting. A total 171 patients with STEMI were randomized to 80-mg atorvastatin (n = 86) or 10-mg atorvastatin (n = 85) arms for pre-treatment before PCI. All patients were prescribed clopidogrel (600 mg) before PCI. After PCI, both groups were treated with atorvastatin (10 mg). The primary end point was 30-day incidence of MACE including death, nonfatal MI, and target vessel revascularization. Secondary end points included corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, and ST-segment resolution at 90 min after PCI. MACE occurred in 5 (5.8%) and 9 (10.6%) patients in the 80-mg and 10-mg atorvastatin pre-treatment arms, respectively (p = 0.26). Corrected thrombolysis in myocardial infarction frame count was lower in the 80-mg atorvastatin arm (26.9 +/- 12.3 vs. 34.1 +/- 19.0, p = 0.01). Myocardial blush grade and ST-segment resolution were also higher in the 80-mg atorvastatin arm (2.2 +/- 0.8 vs. 1.9 +/- 0.8, p = 0.02 and 61.8 +/- 26.2 vs. 50.6 +/- 25.8%, p = 0.01). High-dose atorvastatin pre-treatment before PCI did not show a significant reduction of MACEs compared with low-dose atorvastatin but did show improved immediate coronary flow after primary PCI. High-dose atorvastatin may produce an optimal result for STEMI patients undergoing PCI by improving microvascular myocardial perfusion. (Efficacy of High-Dose AtorvaSTATIN Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction [STATIN STEMI]; NCT00808717).