Document Detail

Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction.
MedLine Citation:
PMID:  19664895     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Atorvastatin administered at least 7 days before the percutaneous coronary intervention (PCI) reduces the rate of periprocedural myocardial infarction (MI). It is unknown whether a single, high (80 mg) loading dose of atorvastatin may reduce the rate of periprocedural MI. BACKGROUND: Periprocedural MI is a prognostically important complication of PCI. METHODS: The day before the elective PCI, 668 statin-naive patients were randomly assigned to atorvastatin 80 mg (atorvastatin group; n = 338) or no statin treatment (control group; n = 330). Creatine kinase-myocardial isoenzyme (CK-MB) (upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (ULN 0.10 ng/ml) were assessed before and 6 and 12 h after the intervention. Periprocedural MI was defined as a CK-MB elevation >3x ULN alone or associated with chest pain or ST-segment or T-wave abnormalities. RESULTS: The incidence of a periprocedural MI was 9.5% in the atorvastatin group and 15.8% in the control group (odds ratio: 0.56; 95% confidence interval: 0.35 to 0.89; p = 0.014). Median CK-MB peak after PCI was 2.10 ng/ml (interquartile range 1.00 to 12.50 ng/ml) in the atorvastatin group and 3.20 ng/ml (interquartile range 1.37 to 16.07 ng/ml) in the control group (p = 0.014). The incidence of cardiac troponin I elevation >3x ULN was 26.6% in the atorvastatin group and 39.1% in the control group (odds ratio: 0.56; 95% confidence interval: 0.40 to 0.78; p < 0.001). CONCLUSIONS: A single, high (80 mg) loading (within 24 h) dose of atorvastatin reduces the incidence of periprocedural MI in elective PCI.
Carlo Briguori; Gabriella Visconti; Amelia Focaccio; Bruno Golia; Alaide Chieffo; Alfredo Castelli; Marco Mussardo; Matteo Montorfano; Bruno Ricciardelli; Antonio Colombo
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Publication Detail:
Type:  Clinical Trial, Phase II; Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-08-06
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-27     Completed Date:  2010-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2157-63     Citation Subset:  AIM; IM    
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121 Naples, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Dose-Response Relationship, Drug
Electrocardiography / drug effects
Heptanoic Acids / administration & dosage*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Middle Aged
Myocardial Infarction / physiopathology,  therapy*
Myocardial Reperfusion Injury / physiopathology,  prevention & control*
Pyrroles / administration & dosage*
Treatment Outcome
Reg. No./Substance:
0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Pyrroles; 110862-48-1/atorvastatin
Comment In:
J Am Coll Cardiol. 2009 Dec 1;54(23):2164-6   [PMID:  19775848 ]

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