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

 Jung-Sun Kim  ;  Jaedeok Kim  ;  Donghoon Choi  ;  Chan Joo Lee  ;  Sang Hak Lee  ;  Young-Guk Ko  ;  Myeong-Ki Hong  ;  Byoung-Keuk Kim  ;  Seong Jin Oh  ;  Dong Woon Jeon  ;  Joo-Young Yang  ;  Jung Rae Cho  ;  Nam-Ho Lee  ;  Yun-Hyeong Cho  ;  Deok-Kyu Cho  ;  Yangsoo Jang 
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Issue Date
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
statin ; percutaneous transluminal coronary angioplasty ; acute myocardial infarction
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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).
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jae Deok(김재덕)
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Lee, Sang Hak(이상학) ORCID logo https://orcid.org/0000-0002-4535-3745
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
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