Intensive Statin Therapy in NSTE-ACS Patients Undergoing PCI: Clinical and Biochemical Effects

摘要

Early initiation of statin therapy in acute coronary syndrome patients has a favorable prognostic impact because of its anti-inflammatory and antithrombotic properties. In this study, we explored the effect of atorvastatin-loading, followed by intensive atorvastatin therapy, on clinical and biochemical outcomes in non-ST-segment-elevation acute coronary syndrome patients who were scheduled for percutaneous coronary intervention. We prospectively enrolled 140 patients (mean age, 56 ± 9 years, 68% men). Once eligible, patients were randomly assigned to receive either a moderate 20-mg daily dose of atorvastatin (Group A) or a 160-mg loading dose followed by an intensified 80-mg daily dose (Group B). High-sensitivity C-reactive protein (hs-CRP) levels were recorded before and after intervention. Evaluation after 6 months included hs-CRP levels, left ventricular systolic function, and major adverse cardiac events. We found no significant difference between the 2 groups in regard to the interventional data. However, blood sampling after coronary intervention, and again 6 months later, revealed a significant decline in mean hs-CRP level among Group B patients (P 1 Inflammatory processes are involved in almost all states of atherosclerotic disease progression and are especially important in the initiation of ACS. 2 C-reactive protein (CRP) is an acute-phase reactant that is considered to be a biomarker of inflammation. 3 It also plays an active role in the progression of atherosclerosis, through its direct pro-atherogenic effects on the vasculature. 4 Serum CRP is a strong independent predictor of future cardiovascular events. High CRP levels predict an increase of risk that goes beyond classical risk factors. 5 Similarly, serum CRP levels are elevated in patients with unstable coronary artery disease, as opposed to those with stable levels. 6 This protein is produced chiefly by the liver, in response to proinflammatory cytokines, and is secreted into the systemic circulation. 7 It has been reported that, in endothelial cells, CRP increases the expression of cell-adhesion molecules 8 and decreases endothelial nitric oxide synthase expression and activity. 9 Moreover, it promotes the production of reactive oxygen species. 10 Statins, the competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are associated with further risk reduction in patients with coronary artery disease. 11 In addition to their lipid-lowering properties, these agents exhibit pleiotropic properties, both in vivo and in vitro. 12 These drugs decrease reactive oxygen species production, reduce vascular smooth-muscle-cell proliferation, exhibit antithrombotic and anti-inflammatory effects, increase the production of nitric oxide in endothelial cells by the up-regulation of endothelial nitric oxide synthase expression, and stabilize atherosclerotic plaques. 13 Moreover, statins are able to decrease CRP levels in hyperlipidemic patients. 14 Data from randomized controlled trials have indicated that intensive lipid-lowering by means of statins provides additional clinical benefits after ACS. 15 , 16 However, data are scarce on the impact of long-term intensive statin treatment on left ventricular (LV) systolic function.