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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