Statin therapy should start seven days prior to elective angioplasty to decrease risk for procedure-associated myocardial infarction
Statin therapy should start seven days prior to
elective angioplasty to decrease risk for procedure-associated myocardial
infarction, according to study results presented at the Sixteenth Annual
Transcatheter Cardiovascular Therapeutics Scientific Symposium.
"Several recent studies have suggested that
patients already taking statins at the time of procedure may have a lower
risk of myocardial infarction during angioplasty, but this hypothesis has
never been confirmed by a randomized trial," said Vincenzo Pasceri,
MD, PhD, who represented the Italian researchers. "Several large epidemiologic
studies have also shown that patients with a small myocardial infarction
during angioplasty have poorer long-term prognosis, with a higher risk
of new cardiac events and death."
The ARMYDA (Atorvastatin for Reduction of Myocardial
Damage during Angioplasty) trial enrolled 153 patients. A total of 76 were
randomized to 40 mg/day of atorvastatin and 77 to placebo seven days before
surgery. All patients were treated with atorvastatin after the procedure.
"We found that the incidence of myocardial infarction
during angioplasty was much lower for patients taking atorvastatin, more
specifically, 5% of patients taking the statin compared with 18% receiving
placebo," said Pasceri. "All markers of myocardial necrosis were
much lower in the atorvastatin group. There was also a trend to lower C-reactive
protein levels in the statin group, suggesting lower inflammatory activation."
Pasceri explained that while the mechanisms for the
beneficial effects of atorvastatin were not completely understood, they
were not related to the statin's lipid-lowering effect. The data suggested
that the anti-inflammatory effect of atorvastatin might have a role by
either stabilizing plaque or by a protective effect on the myocardium.
"Current treatment guidelines do not suggest
taking statin treatment prior to surgery in patients suspected of coronary
disease," Pasceri said. "Since atorvastatin is safe and a seven-day
treatment is relatively inexpensive, we strongly recommend the use of statins
to be used in all patients with suspected coronary disease before undergoing
a coronary angiogram with possible angioplasty."
The Cardiovascular Research Foundation is a leading
organization dedicated to advancing the science of interventional vascular
medicine and improving patient outcomes through research and education.
TCT 2004 is the world's largest, most original scientific symposium for
healthcare professionals dedicated to interventional vascular therapy.
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