Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention Results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial
Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention Results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial
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DOI：
10.1016/j.jacc.2009.05.028
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发表时间：
2009-08-04
影响因子：
24
通讯作者：
Montinaro, Antonio
中科院分区：
文献类型：
--
作者：
Di Sciascio, Germano;Patti, Giuseppe;Montinaro, Antonio
目的探讨急性阿托伐他汀负荷对接受慢性他汀类药物治疗的患者围术期心肌损害的保护作用。研究背景：阿托伐他汀短期预治疗可减少稳定型心绞痛合并急性冠状动脉综合征患者介入治疗期间的心肌梗死。方法383例患者年龄66±10岁，305名有稳定型心绞痛(53%)或无ST段抬高的急性冠状动脉综合征(47%)且接受慢性他汀类药物(55%)接受经皮冠状动脉介入治疗的患者随机分为两组：阿托伐他汀再负荷组(介入前12小时80 mg，术前再加40 mg剂量[n=192])或安慰剂(n=191)。所有患者此后均接受长期阿托伐他汀治疗(40毫克/天)。主要终点是30天内主要不良心脏事件(心脏死亡、心肌梗死或计划外血管重建)的发生率。结果接受阿托伐他汀再负荷治疗的患者中，主要终点的发生率为3.7%，安慰剂组为9.4%(p=0.037)；这一差异主要是由于围手术期心肌梗死的减少。阿托伐他汀组术后肌酸激酶-心肌带和肌钙蛋白-I高于正常上限的发生率较低(分别为13%和24%，p=0.017和37%和49%，p=0.021)。多变量分析证实阿托伐他汀再负荷是降低30天内主要不良心脏事件发生率风险的预测因子(优势比：0.5，95%可信区间：0.2~0.80；p=0.039)，主要发生在急性冠脉综合征患者(相对风险降低82%；p=0.027)。结论阿托伐他汀再负荷试验表明，大剂量阿托伐他汀再负荷可改善接受长期他汀类药物治疗的患者的临床结局。这些发现可能支持在干预前早期常规服用大剂量阿托伐他汀的策略，即使在慢性治疗的背景下也是如此。(J Am Coll心脏ol 2009；54：558-65)(C)美国心脏病学会基金会2009年
Objectives This study was designed to investigate whether an acute atorvastatin reload before percutaneous coronary intervention (PCI) protects patients receiving chronic statin therapy from periprocedural myocardial damage.Background Previous ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) studies demonstrated that short-term pre-treatment with atorvastatin reduces myocardial infarction during PCI in statin-naive patients with both stable angina and acute coronary syndromes.Methods A total of 383 patients (age 66 +/- 10 years, 305 men) with stable angina (53%) or non-ST-segment elevation acute coronary syndromes (47%) and chronic statin therapy (55% atorvastatin) undergoing PCI were randomized to atorvastatin reload (80 mg 12 h before intervention, with a further 40-mg pre-procedural dose [n = 192]) or placebo (n = 191). All patients received long-term atorvastatin treatment thereafter (40 mg/day). The primary end point was 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unplanned revascularization).Results The primary end point occurred in 3.7% of patients treated with atorvastatin reload and in 9.4% in the placebo arm (p = 0.037); this difference was mostly driven by reduction in periprocedural myocardial infarction. There was lower incidence of post-procedural creatine kinase-myocardial band and troponin-I elevation greater than the upper limit of normal in the atorvastatin arm (13% vs. 24%, p = 0.017, and 37% vs. 49%, p = 0.021, respectively). Multivariable analysis identified atorvastatin reload as a predictor of decreased risk of 30-day incidence of major adverse cardiac events (odds ratio: 0.50, 95% confidence interval: 0.20 to 0.80; p = 0.039), mainly in patients with acute coronary syndromes (82% relative risk reduction; p = 0.027).Conclusions The ARMYDA-RECAPTURE trial suggests that reloading with high-dose atorvastatin improves the clinical outcome of patients on chronic statin therapy undergoing PCI. These findings may support a strategy of routine reload with high-dose atorvastatin early before intervention even in the background of chronic therapy. (J Am Coll Cardiol 2009; 54: 558-65) (C) 2009 by the American College of Cardiology Foundation