ISSN 2996-8215
International Journal of Cardiology | Vol. 13, No. 12, December 2022 | pp. 81–88
DOI: 10.46882/2022/IJC/000164
Original Research Article
High-Dose Atorvastatin Loading Safeguards Against Periprocedural Myocardial Infarction During Bifurcation Percutaneous Coronary Intervention
Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²
¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
²Division of Interventional Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
Abstract:
Periprocedural myocardial infarction (pMI) is a frequent complication during complex percutaneous coronary intervention (PCI). Statin reloading has shown efficacy in limiting pMI in general cohorts, but its impact during complex interventions in patients already established on maintenance statin treatment requires validation. This prospective, randomized, open-label trial evaluated whether high-dose atorvastatin reloading before complex PCI reduces pMI rates in patients on chronic statin therapy. We enrolled 240 chronic statin users undergoing complex PCI (defined as multi-vessel disease, bifurcation lesions, or total occlusions). Patients were randomized 1:1 to receive either an acute reload of atorvastatin (80 mg given 12 hours and 2 hours pre-PCI, n = 120) or to continue standard maintenance dosing (n = 120). The primary endpoint was the incidence of pMI, defined as an elevation of cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours post-procedure. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the control arm (8.3% vs. 17.5%, p = 0.03). Post-procedural mean cTnI values were also significantly reduced with the reload (0.44 ± 0.12 ng/mL vs. 0.92 ± 0.22 ng/mL, p < 0.01). No cases of hepatic dysfunction or rhabdomyolysis occurred. High-dose atorvastatin reloading safely and significantly reduces periprocedural myocardial injury during complex percutaneous coronary intervention in patients on chronic maintenance statin therapy.
Keywords: Percutaneous coronary intervention, Atorvastatin, Statin reloading, Periprocedural myocardial infarction, Complex coronary lesions
Received: September 15, 2022; Revised: October 28, 2022; Accepted: November 12, 2022; Published: December 19, 2022