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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 study 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

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