EFFICACY OF HIGH-DOSE ATORVASTATIN PRETREATMENT IN PATIENTS WITH NSTEMI UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

Abstract

Cardiovascular disease causes a substantial burden of morbidity and remains the leading cause of death in Europe despite continued improvements. It is responsible for close to 4.1 million deaths per year, 20% of which are due to coronary artery disease. Percutaneous coronary intervention (PCI) is considered to be the preferred reperfusion strategy for acute coronary syndrome (ACS). Several studies reported that administration of statins before PCI might reduce the incidence of adverse effects after the procedure. The latest guidelines also advocate the use of high intensity statin therapy in patients with STEMI and NSTEMI. This was attributed to the pleotropic effects of statins. The aim of this study was is to investigate whether high doses of statins when initiated on presentation with NSTEMI and after PCI will lower NT- proBNP levels post PCI. The study prospectively enrolled seventy patients presenting with NSTEMI and scheduled for PCI. They were randomized into two groups, the first of which (group A) received a loading dose of Atorvastatin of 160 mg prior to PCI followed by a daily maintenance dose of 80 mg. The other group (group B) received a moderate dose of 20 mg daily. NT- proBNP levels were assessed before and after PCI in both patient groups as well as angiographic assessment of TIMI flow and modified Gensini scores. Three months MACE follow-up was done for both patient groups. The mean age of patients enrolled in the study was 55.3 ±11.6 years in group A and 56.9± 9.7 in group B (with no significant age difference in both groups). 90% of the total patient population were males, of which 91.4% were enrolled in group A. Risk factors and baseline laboratory data were similar in both groups. Mean Modified Gensini score in patients in group A was 7.48 ±0.71, compared to 8.74±0.54 in group B. The difference in the Modified Gensini scores between the two studied groups was not statistically significant (p=0.09). There was no statistically significant difference between the two groups regarding TIMI flow. Patients in group A had significantly lower NT- proBNP levels post PCI compared to group B (p=0.01). The incidence of MACE at 3 months was significantly greater (p= 0.03) in group B, where six patients experienced MI, of which four had target vessel revascularization. MI occurred in one patient in group A. Both high and moderate dose Atorvastatin therapy lowered NT- proBNP values after PCI, moreover, high dose Atorvastatin therapy pretreatment in NSTEMI patients preceding PCI led to significantly lower NT- pro BNP values after PCI than moderate dose therapy which is an indication of the greater pleotropic effects of statins expected with high dose statin therapy. High dose maintenance therapy for three months also has favorable outcomes in terms of MACE.