efficacy of high dose atorva efficacy of high dose atorva STATIN STATIN loading before primary percutaneous loading before primary percutaneous coronary intervention in coronary intervention in ST E ST E levation levation M M yocardial yocardial I I nfarction (STATIN STEMI) nfarction (STATIN STEMI) Jung-Sun Kim, MD, PhD*, Jaedeok Kim, MD*, Chan Joo Lee, MD*, Donghoon Choi, MD, PhD*, Byung-Ho Lee, MD*, Sang Hak Lee, MD, Ph D*, Young-Guk Ko, MD*, Jong-Won Ha, MD, Ph D*, Myeong-Ki Hong, MD, Ph D*, Yangsoo Jang, MD, PhD, FACC*, Byoung-Keuk Kim MD, Ph D†, Seong Jin Oh MD†, Dong Woon Jeon MD†, Joo-Young Yang MD†, Jung Rae Cho, MD‡, Jae-Hun Jung, MD‡, Nam-Ho Lee, MD, Ph D‡, Yun-Hyeong Cho, MD§, Deok-Kyu Cho, MD, Ph D§ *Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea †Division of Cardiology, Kangnam Sacred Heart Hospital, Seoul, Korea ‡Division of Cardiology, NHIC Ilsan Hospital, Koyang, Korea §Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
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Efficacy of high dose atorvaSTATIN loading before primary percutaneous coronary intervention in ST Elevation Myocardial Infarction (STATIN STEMI) Jung-Sun.
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efficacy of high dose atorvaefficacy of high dose atorvaSTATINSTATIN loading loading
before primary percutaneous coronary before primary percutaneous coronary
intervention in intervention in ST EST Elevation levation MMyocardial yocardial
*Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of
Medicine, Seoul, Korea
†Division of Cardiology, Kangnam Sacred Heart Hospital, Seoul, Korea
‡Division of Cardiology, NHIC Ilsan Hospital, Koyang, Korea
§Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Kwandong
University College of Medicine, Goyang, Korea
The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction
Celik T, et al. Coronary Artery Disease 2005
Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40mg.
Atorvastatin for at least 6 months compared with that of the patients taking no statin (p < 0.001).
After confounding variables were controlled for, the mean TIMI frame count of patients in group 2 was significantly lower than that of the patients in group 1 (p = 0.001).
Backgrounds
• Although statin prior to PCI has favorable effects in stable angina
and ACS except ST elevation MI (STEMI), there have have been
few studies for STEMI.
Celik T et al. reported in patients with STEMI that prior statin use
may improve coronary blood flow after PCI in patients with AMI.
• But this study was retrospective, nonrandomized study and
evaluated the effects for chronic statin therapy no acute high
dose effect.
The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction
Hypothesis
• We investigate whether acute high-dose
statin prior to primary PCI can have
beneficial effect or not for
periprocedural period and 30 days-
cardiac events.
Study Design
Inclusion Criteria
• The patient must be at least 18-80 years of age.
• The patient had the symptoms of acute myocardial
infaction within 12 hours with ST segment elevation of
more than 1 mm in at least two contiguous leads of
EKG or new onset LBBB.
• The patient or guardian agrees to the study protocol
and provides informed, written consent.
• Patients with any of the following will be excluded from participation:
• Patients to whom PCI can not be undergone within 12 hours from receiving the study drug
• Cardiogenic shock or symptomatic hypotension or sitting SBP < 95 mmHg
• The history of major surgery, trauma, retinal hemorrhage, significant gastrointestinal or genitourinary bleeding within recent 6 weeks; history of cerebrovascular attack within two years, or cerebrovascular attack with a significant residual neurological deficit
• Severe or malignant hypertension (= sitting SBP > 180 mmHg and/or sitting DBP > 105 mmHg)
• The history or diagnosis of vasculitis; renal insuffiency (the level of serum creatinine is two times higher than the upper limit of normal of each center)
• The patients who might die of other disease than cardiac disease during the trial.
Exclusion Criteria
Primary End-Point
To evaluate the effect of high-dose Atorvastatin (started at emergency room) in STEMI