NEW YORK (Reuters Health) – There’s now one more reason for statin loading before percutaneous coronary intervention. As well as reducing myocardial damage, high-dose atorvastatin given shortly before PCI reduces the risk of nephropathy caused by the angiography contrast medium, an Italian team reports in the American Journal of Cardiology online April 27.
Dr. Germano Di Sciascio, at Campus Bio-Medico University in Rome, and colleagues previously noticed that PCI patients on long-term statin therapy were less likely to develop postprocedure contrast-induced nephropathy. This prompted them to conduct a randomized trial of short-term, high-dose statin therapy to prevent the condition.
The trial involved 241 statin-naive patients with non-ST-segment elevated ACS who underwent PCI within 48 hours. They were randomized to receive 80 mg atorvastatin or placebo 12 hours before coronary angiography, with another 40 mg atorvastatin or placebo given immediately before the procedure.
Contrast-induced nephropathy, defined as an increase in serum creatinine of at least 0.5 mg/dL or more than 25% from baseline, developed in 6 of 120 (5.0%) patients in the atorvastatin group compared with 16 of 121 (13.2%; p=0.046) in the placebo arm, the investigators found.
Specifically, they report, “In the subgroup without baseline chronic renal failure, incidence of CIN (contrast-induced nephropathy) was 1% in the atorvastatin versus 7% in the placebo group (odds ratio 0.15, p = 0.11), whereas in patients with chronic renal failure it was 14% versus 26% (odds ratio 0.48, p = 0.36).”
Furthermore, length of stay was 2.9 days in the atorvastatin arm compared with 3.2 days in the placebo group (p=0.007), and 3.5 days in patients who developed contrast-induced nephropathy versus 2.9 days in those who did not (p=0.001), according to the report.
“These results lend further support to early use of high-dose statins as adjuvant pharmacologic therapy before percutaneous coronary revascularization,” Dr. Di Sciascio and colleagues conclude.
Short-Term, High-Dose Atorvastatin Pretreatment to Prevent Contrast-Induced Nephropathy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention (from the ARMYDA-CIN [Atorvastatin for Reduction of MYocardial Damage during Angioplasty–Contrast-Induced Nephropathy] Trial
Am J Cardiol 2011.