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Protection From Procedural Myocardial Injury by Atorvastatin Is Associated With Lower Levels of Adhesion Molecules After Percutaneous Coronary Intervention

Results From the ARMYDA-CAMs (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules) Substudy

Giuseppe Patti, MD^_*, Massimo Chello, MD^_*, Vincenzo Pasceri, MD, PhD, FACC, Diego Colonna, MD, Annunziata Nusca, MD^_*, Marco Miglionico, MD^_*, Andrea D’Ambrosio, MD^_*, Elvio Covino, MD^_* and Germano Di Sciascio, MD, FACC^_*,_*

^_* Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Rome, Italy
Interventional Cardiology Unit, San Filippo Neri Hospital of Rome, Rome, Italy
Second University of Naples, Naples, Italy

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Design of the ARMYDA-CAMs (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules) substudy. CAMs = cell adhesion molecules; CK-MB = creatine kinase-MB; CRP = C-reactive protein; ICAM-1 = intercellular cell adhesion molecule-1; PCI = percutaneous coronary intervention; VCAM-1 = vascular cell adhesion molecule-1.

View larger version (25K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Soluble intercellular cell adhesion molecule-1 (ICAM-1, top), E-selectin (middle), and vascular cell adhesion molecule-1 (VCAM-1, bottom) levels in the 2 arms at randomization (i.e., 7 days before intervention), at the time of intervention, after 8 and 24 h. The Wilcoxon signed rank test with Bonferroni’s correction for the comparisons between time points in both arms showed a significant rise from baseline of ICAM-1, E-selectin, and VCAM-1 levels (p < 0.01) in all post-procedural determinations. This increase was significantly lower in the atorvastatin versus placebo arm at 8 and 24 h for E-selectin and at 24 h for ICAM-1. Data are mean ± SEM. PCI = percutaneous coronary intervention. White bars = atorvastatin; black bars = placebo.

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Post-procedural 24-h percent increase from baseline of adhesion molecule levels. ICAM-1 = intercellular cell adhesion molecule-1; VCAM-1 = vascular cell adhesion molecule-1. White bars = atorvastatin; black bars = placebo.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 4 (A) Incidence of procedural myocardial damage in patients of both arms according to post-procedural E-selectin peak levels. (Low E-selectin: <67 ng/ml, median value; high E-selectin: 67 ng/ml). (B) Post-procedural E-selectin peak levels (mean ± SEM) in patients with or without procedural myocardial damage (defined as post-procedural troponin-I elevation above normal limits). White bars = atorvastatin; black bars = placebo.