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
- PMID: 19643320
- DOI: 10.1016/j.jacc.2009.05.028
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
Abstract
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-naïve 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.
Comment in
-
Recapturing the magic: revisiting the pleiotropic effects of statins in percutaneous coronary revascularization.J Am Coll Cardiol. 2009 Aug 4;54(6):566-8. doi: 10.1016/j.jacc.2009.04.070. Epub 2009 Jul 2. J Am Coll Cardiol. 2009. PMID: 19643321 No abstract available.
-
Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention.Curr Atheroscler Rep. 2010 Jan;12(1):8-10. doi: 10.1007/s11883-009-0083-x. Curr Atheroscler Rep. 2010. PMID: 20425264 No abstract available.
Similar articles
-
Comparison of high reloading ROsuvastatin and Atorvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of MyocArdial periprocedural necrosis. The ROMA II trial.Int J Cardiol. 2013 Oct 9;168(4):3715-20. doi: 10.1016/j.ijcard.2013.06.017. Epub 2013 Jul 11. Int J Cardiol. 2013. PMID: 23849964 Clinical Trial.
-
Statin loading before percutaneous coronary intervention: proposed mechanisms and applications.Future Cardiol. 2010 Sep;6(5):579-89. doi: 10.2217/fca.10.77. Future Cardiol. 2010. PMID: 20932108 Review.
-
Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the STATIN STEMI trial.JACC Cardiovasc Interv. 2010 Mar;3(3):332-9. doi: 10.1016/j.jcin.2009.11.021. JACC Cardiovasc Interv. 2010. PMID: 20298994 Clinical Trial.
-
Atorvastatin efficacy in the primary and secondary prevention of cardiovascular events.Drugs. 2007;67 Suppl 1:29-42. doi: 10.2165/00003495-200767001-00004. Drugs. 2007. PMID: 17910519 Review.
-
Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial.J Am Coll Cardiol. 2007 Mar 27;49(12):1272-8. doi: 10.1016/j.jacc.2007.02.025. J Am Coll Cardiol. 2007. PMID: 17394957 Clinical Trial.
Cited by
-
Colchicine efficacy comparison at varying time points in the peri-operative period for coronary artery disease: a systematic review and meta-analysis of randomized controlled trials.Front Cardiovasc Med. 2023 Aug 4;10:1156980. doi: 10.3389/fcvm.2023.1156980. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 37600022 Free PMC article. Review.
-
Effects of statins on the incidence and outcomes of acute kidney injury in critically ill patients: a systematic review and meta-analysis.Arch Med Sci. 2023 Jan 27;19(4):952-964. doi: 10.5114/aoms/159992. eCollection 2023. Arch Med Sci. 2023. PMID: 37560738 Free PMC article. Review.
-
Evaluation and subgroup analysis of the efficacy and safety of intensive rosuvastatin therapy combined with dual antiplatelet therapy in patients with acute ischemic stroke.Eur J Clin Pharmacol. 2023 Mar;79(3):389-397. doi: 10.1007/s00228-022-03442-8. Epub 2022 Dec 29. Eur J Clin Pharmacol. 2023. PMID: 36580143 Free PMC article. Clinical Trial.
-
Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients.Cureus. 2022 Nov 17;14(11):e31602. doi: 10.7759/cureus.31602. eCollection 2022 Nov. Cureus. 2022. PMID: 36540477 Free PMC article.
-
Washed microbiota transplantation improves patients with metabolic syndrome in South China.Front Cell Infect Microbiol. 2022 Nov 15;12:1044957. doi: 10.3389/fcimb.2022.1044957. eCollection 2022. Front Cell Infect Microbiol. 2022. PMID: 36457852 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous