This Article Figures Only Full Text Full Text (PDF) Online Appendix All Versions of this Article: j.jacc.2009.05.028v1 54/6/558    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Di Sciascio, G. Articles by Montinaro, A. Search for Related Content PubMed PubMed Citation Articles by Di Sciascio, G. Articles by Montinaro, A. Related Collections Related Article

EXPEDITED PUBLICATION

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

Germano Di Sciascio, MD^_*,_*, Giuseppe Patti, MD^_*, Vincenzo Pasceri, MD, Achille Gaspardone, MD, Giuseppe Colonna, MD and Antonio Montinaro, MD

^_* Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
Interventional Cardiology Unit, San Filippo Neri Hospital of Rome, Rome, Italy
Cardiology Unit, Sant'Eugenio Hospital of Rome, Rome, Italy
Interventional Cardiology Unit, Vito Fazzi Hospital of Lecce, Lecce, Italy

Manuscript received March 13, 2009; revised manuscript received May 1, 2009, accepted May 4, 2009.

^_* Reprint requests and correspondence: Prof. Germano Di Sciascio, Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy (Email: g.disciascio{at}unicampus.it).

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.

Key Words: coronary artery disease • atorvastatin • percutaneous coronary intervention • myocardial infarction

Abbreviations and Acronyms   ACS = acute coronary syndrome   CK-MB = creatine kinase-myocardial band   CRP = C-reactive protein   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention   ULN = upper limit of normal

Related Article

Recapturing the Magic: Revisiting the Pleiotropic Effects of Statins in Percutaneous Coronary Revascularization

Stephen G. Ellis and Saif Anwaruddin
J. Am. Coll. Cardiol. 2009 54: 566-568. [Full Text] [PDF]

This article has been cited by other articles:

				U. Laufs and O. Adam Acute Effects of Statins J. Am. Coll. Cardiol., January 3, 2012; 59(1): 71 - 73. [Full Text] [PDF]

				A. Liuni, M. C. Luca, T. Gori, and J. D. Parker Loss of the preconditioning effect of rosuvastatin during sustained therapy: a human in vivo study Am J Physiol Heart Circ Physiol, January 1, 2012; 302(1): H153 - H158. [Abstract] [Full Text] [PDF]

				G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): e44 - e122. [Full Text] [PDF]

				G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, S. M. Hollenberg, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions J. Am. Coll. Cardiol., December 6, 2011; 58(24): 2550 - 2583. [Full Text] [PDF]

				Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): e574 - e651. [Full Text] [PDF]

				Writing Committee Members, G. N. Levine, E. R. Bates, J. C. Blankenship, S. R. Bailey, J. A. Bittl, B. Cercek, C. E. Chambers, S. G. Ellis, R. A. Guyton, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation, December 6, 2011; 124(23): 2574 - 2609. [Full Text] [PDF]

				Developed with the special contribution of: Europe, Authors/Task Force Members, Z. Reiner, A. L. Catapano, G. De Backer, I. Graham, M.-R. Taskinen, O. Wiklund, S. Agewall, E. Alegria, et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Eur. Heart J., July 2, 2011; 32(14): 1769 - 1818. [Full Text] [PDF]

				E. W. Kuhn, O. J. Liakopoulos, Y. H. Choi, and T. Wahlers Current Evidence for Perioperative Statins in Cardiac Surgery Ann. Thorac. Surg., July 1, 2011; 92(1): 372 - 379. [Abstract] [Full Text] [PDF]

				D. T. Ko, H. C. Wijeysundera, L. Yun, P. C. Austin, W. J. Cantor, and J. V. Tu Effectiveness of Preprocedural Statin Therapy on Clinical Outcomes for Patients With Stable Coronary Artery Disease After Percutaneous Coronary Interventions Circ Cardiovasc Qual Outcomes, July 1, 2011; 4(4): 459 - 466. [Abstract] [Full Text] [PDF]

				C. W. Lee, C.-S. Park, I. Hwang, Y. Kim, D.-W. Park, S.-J. Kang, S.-H. Lee, Y.-H. Kim, S.-W. Park, and S.-J. Park Expression of HMG-CoA reductase in human coronary atherosclerotic plaques and relationship to plaque destabilisation Heart, May 1, 2011; 97(9): 715 - 720. [Abstract] [Full Text] [PDF]

				G. Patti, C. P. Cannon, S. A. Murphy, S. Mega, V. Pasceri, C. Briguori, A. Colombo, K. H. Yun, M. H. Jeong, J.-S. Kim, et al. Clinical Benefit of Statin Pretreatment in Patients Undergoing Percutaneous Coronary Intervention: A Collaborative Patient-Level Meta-Analysis of 13 Randomized Studies Circulation, April 19, 2011; 123(15): 1622 - 1632. [Abstract] [Full Text] [PDF]

				G. Ganesha Babu, J. Malcolm Walker, D. M. Yellon, and D. J. Hausenloy Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection Eur. Heart J., January 1, 2011; 32(1): 23 - 31. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., December 14, 2010; 56(25): 2126 - 2138. [Full Text] [PDF]

				J.-C. Tardif, P. L. L'Allier, J. Gregoire, R. Ibrahim, G. McFadden, W. Kostuk, M. Knudtson, M. Labinaz, R. Waksman, C. J. Pepine, et al. A Randomized Controlled, Phase 2 Trial of the Viral Serpin Serp-1 in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention Circ Cardiovasc Interv, December 1, 2010; 3(6): 543 - 548. [Abstract] [Full Text] [PDF]

				L. Sarov-Blat, J. M. Morgan, P. Fernandez, R. James, Z. Fang, M. R. Hurle, C. Baidoo, R. N. Willette, J. J. Lepore, S. E. Jensen, et al. Inhibition of p38 Mitogen-Activated Protein Kinase Reduces Inflammation After Coronary Vascular Injury in Humans Arterioscler Thromb Vasc Biol, November 1, 2010; 30(11): 2256 - 2263. [Abstract] [Full Text] [PDF]

				K. A. Eagle and V. Chopra Statins Before Coronary Procedures: A New Indication for an Old Friend J. Am. Coll. Cardiol., September 28, 2010; 56(14): 1110 - 1112. [Full Text] [PDF]

				D. E. Winchester, X. Wen, L. Xie, and A. A. Bavry Evidence of Pre-Procedural Statin Therapy: A Meta-Analysis of Randomized Trials J. Am. Coll. Cardiol., September 28, 2010; 56(14): 1099 - 1109. [Abstract] [Full Text] [PDF]

				Jie Li, W.-M. Lu, X.-X. Li, S.-M. Wang, J.-X. Yu, Y.-F. Zhu, D.-Y. Liu, and M.-Q. Huang Intensive Statin Therapy: A Favorable Adjunct to the Improvement of Small-Diameter Vascular Grafts Angiology, July 1, 2010; 61(5): 427 - 436. [Abstract] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., May 18, 2010; 55(20): 2272 - 2286. [Full Text] [PDF]

				F. Cuculi, C. C. S. Lim, and A. P. Banning Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented? Heart, May 1, 2010; 96(10): 736 - 740. [Abstract] [Full Text] [PDF]

				J.-S. Kim, J. Kim, D. Choi, C. J. Lee, S. H. Lee, Y.-G. Ko, M.-K. Hong, B.-K. Kim, S. J. Oh, D. W. Jeon, et al. Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: The STATIN STEMI Trial J. Am. Coll. Cardiol. Intv., March 1, 2010; 3(3): 332 - 339. [Abstract] [Full Text] [PDF]

				C. J. Lavie and R. V. Milani High-Dose Atorvastatin in Acute Coronary and Cerebrovascular Syndromes J. Am. Coll. Cardiol. Intv., March 1, 2010; 3(3): 340 - 342. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2009 J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407. [Full Text] [PDF]

				B. R. Chaitman, R. M. Hardison, D. Adler, S. Gebhart, M. Grogan, S. Ocampo, G. Sopko, J. A. Ramires, D. Schneider, R. L. Frye, et al. The Bypass Angioplasty Revascularization Investigation 2 Diabetes Randomized Trial of Different Treatment Strategies in Type 2 Diabetes Mellitus With Stable Ischemic Heart Disease: Impact of Treatment Strategy on Cardiac Mortality and Myocardial Infarction Circulation, December 22, 2009; 120(25): 2529 - 2540. [Abstract] [Full Text] [PDF]

				S. Tsimikas High-Dose Statins Prior to Percutaneous Coronary Intervention: A Paradigm Shift to Influence Clinical Outcomes in the Cardiac Catheterization Laboratory J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2164 - 2166. [Full Text] [PDF]

				G. Heusch, P. Kleinbongard, D. Bose, B. Levkau, M. Haude, R. Schulz, and R. Erbel Coronary Microembolization: From Bedside to Bench and Back to Bedside Circulation, November 3, 2009; 120(18): 1822 - 1836. [Abstract] [Full Text] [PDF]

				Statin Reload Beneficial in Percutaneous Coronary Intervention Journal Watch Cardiology, August 19, 2009; 2009(819): 1 - 1. [Full Text]

				S. G. Ellis and S. Anwaruddin Recapturing the Magic: Revisiting the Pleiotropic Effects of Statins in Percutaneous Coronary Revascularization J. Am. Coll. Cardiol., August 4, 2009; 54(6): 566 - 568. [Full Text] [PDF]