This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.06.061v1 48/8/1560    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 Google Scholar Google Scholar Articles by Patti, G. Articles by Di Sciascio, G. Search for Related Content PubMed PubMed Citation Articles by Patti, G. Articles by Di Sciascio, G.

CLINICAL RESEARCH

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

Manuscript received May 10, 2006; revised manuscript received June 19, 2006, accepted June 26, 2006.

^_* Reprint requests and correspondence: Dr. Germano Di Sciascio, Department of Cardiovascular Sciences, Campus Bio-Medico University, Via E. Longoni, 83, 00155 Rome, Italy (Email: g.disciascio{at}unicampus.it).

OBJECTIVES: The goal of this work was to investigate whether protection from myocardial injury during percutaneous coronary intervention (PCI) by atorvastatin is related to reduction of endothelial inflammatory response.

BACKGROUND: In the randomized ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) trial, 7-day pre-treatment with atorvastatin before PCI significantly reduced procedural myocardial injury; mechanisms underlying this effect are not characterized.

METHODS: In a planned subanalysis of the ARMYDA trial, a subgroup of 76 patients was blind-tested for measurement of plasma levels of vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), and E-selectin: 38 patients belonged to atorvastatin (40 mg/day) and 38 to the placebo arm. Adhesion molecules were evaluated 7 days before intervention, immediately before PCI, and after 8 and 24 h.

RESULTS: Reduction of procedural myocardial injury after statin pre-treatment was also confirmed in this subgroup. Intercellular cell adhesion molecule-1, E-selectin, and VCAM-1 levels were not different at randomization and before intervention in either arm. At 8 h, increase of ICAM-1 levels was similar in the 2 arms, whereas 24-h levels were significantly lower in the atorvastatin versus placebo group (282 ± 56 vs. 325 ± 70 ng/ml; p = 0.007). Attenuation of E-selectin elevation occurred at 8 h in the atorvastatin group (50 ± 8 vs. 59 ± 13 ng/ml; p = 0.002) and became even more significant at 24 h (57 ± 9 vs. 73 ± 18 ng/ml; p = 0.0008). Vascular cell adhesion molecule-1 levels were not different at any time point in the 2 arms.

CONCLUSIONS: In patients undergoing PCI, reduction of procedural myocardial injury after 7-day pre-treatment with atorvastatin is paralleled by concomitant attenuation of post-procedural increase of ICAM-1 and E-selectin levels; thus, reduction of endothelial inflammatory response may explain this protective effect of statins.

Abbreviations and Acronyms   ARMYDA = Atorvastatin for Reduction of MYocardial Damage during Angioplasty   ARMYDA-CAMs = Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Cell Adhesion Molecules substudy   CRP = C-reactive protein   ICAM-1 = intercellular cell adhesion molecule-1   VCAM-1 = vascular cell adhesion molecule-1

This article has been cited by other articles:

				G. Patti, A. Nusca, F. Mangiacapra, L. Gatto, A. D'Ambrosio, and G. Di Sciascio Point-of-Care Measurement of Clopidogrel Responsiveness Predicts Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention: Results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) Study J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1128 - 1133. [Abstract] [Full Text] [PDF]

				A. Nusca, R. Melfi, and G. Di Sciascio Review: Percutaneous coronary interventions and statins therapy Therapeutic Advances in Cardiovascular Disease, April 1, 2008; 2(2): 101 - 107. [Abstract] [PDF]

				G. Patti, V. Pasceri, G. Colonna, M. Miglionico, D. Fischetti, G. Sardella, A. Montinaro, and G. Di Sciascio Atorvastatin Pretreatment Improves Outcomes in Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Coronary Intervention: Results of the ARMYDA-ACS Randomized Trial J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1272 - 1278. [Abstract] [Full Text] [PDF]