Document Detail


The impact of pravastatin pre-treatment on periprocedural microcirculatory damage in patients undergoing percutaneous coronary intervention.
MedLine Citation:
PMID:  21596324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study evaluated the effect of pravastatin pre-treatment on post-procedural index of microcirculatory resistance (IMR) values that are introduced for assessing the status of the microcirculation independently of the epicardial area.
BACKGROUND: Pre-treatment with statins decreased the incidence of cardiac enzyme increase after percutaneous coronary intervention (PCI). However, 2 different etiologies, distal embolization of atheroma or ischemia caused by side-branch occlusion, cannot be differentiated by measuring cardiac enzyme levels.
METHODS: Eighty patients with stable angina were randomly assigned to either pravastatin treatment (20 mg/day, n = 40) or no treatment (n = 40) 4 weeks before elective PCI. An intracoronary pressure/temperature sensor-tipped guidewire was used. Thermodilution curves were obtained during maximal hyperemia. The IMR was calculated from the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of mean hyperemic transit time. Creatine kinase-myocardial band and troponin I values were measured at baseline and at 8 and 24 h after PCI.
RESULTS: Post-PCI troponin I levels tended to be lower in patients with pravastatin treatment (median: 0.13 [interquartile range (IQR): 0.10 to 0.31] vs. 0.22 [IQR: 0.10 to 0.74] ng/ml, p = 0.1). However, patients with pravastatin treatment had significantly lower IMR than did patients without pravastatin treatment (median: 12.6 [IQR: 8.8 to 18.0] vs. 17.6 [IQR: 9.7 to 33.9], p = 0.007). Multivariate analysis revealed that the lack of pravastatin pre-treatment was the only independent predictor of post-PCI impaired IMR (p = 0.03).
CONCLUSIONS: Post-PCI measurement of the IMR confirmed that pre-treatment with pravastatin was associated with reduced microvascular dysfunction induced by PCI regardless of side branch occlusions. These data suggest that pre-treatment with statin is desired in patients undergoing elective PCI. (The Impact of Pravastatin Pretreatment on Periprocedural Microcirculatory Damage After Percutaneous Coronary Intervention; UMIN000002885).
Authors:
Kenichi Fujii; Daizo Kawasaki; Katsumi Oka; Hirokuni Akahori; Toshihiro Iwasaku; Masashi Fukunaga; Akiyo Eguchi; Hisashi Sawada; Motomaru Masutani; Masaaki Lee-Kawabata; Takeshi Tsujino; Mitsumasa Ohyanagi; Tohru Masuyama
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  4     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-20     Completed Date:  2011-09-09     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  513-20     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / etiology,  physiopathology,  therapy
Angioplasty, Balloon, Coronary / adverse effects*
Biological Markers / blood
Chi-Square Distribution
Coronary Angiography
Coronary Circulation / drug effects*
Coronary Stenosis / complications,  diagnosis,  physiopathology,  therapy*
Creatine Kinase, MB Form / blood
Female
Heart Diseases / blood,  diagnosis,  etiology,  physiopathology,  prevention & control*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Japan
Linear Models
Logistic Models
Male
Microcirculation / drug effects*
Middle Aged
Pravastatin / administration & dosage*
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Troponin I / blood
Ultrasonography, Interventional
Vascular Resistance
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Troponin I; EC 2.7.3.2/Creatine Kinase, MB Form; KXO2KT9N0G/Pravastatin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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