Randomized Trial of Statin Administration for Myocardial Injury : Is Intensive Lipid-Lowering More Beneficial Than Moderate Lipid-Lowering Before Percutaneous Coronary Intervention?

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Background Minor myocardial damage after percutaneous coronary intervention (PCI) is associated with cardiac risks, which statins seem to reduce. The aim of this study was to examine whether intensive lipid-lowering therapy is more effective in decreasing the risk of cardiac injury after PCI than moderate lipid-lowering therapy. Methods and Results Subjects comprised 42 patients with stable angina without previous statin treatment, randomly assigned to either an intensive lipid-lowering group (Group A: target low-density lipoprotein-cholesterol (LDL-C) <70mg/dl) or a moderate lipid-lowering group (Group B: target LDL-C <100mg/dl) 2 weeks before PCI. All patients took statins to reach target LDL-C levels. Incidence of periprocedural myocardial injury was assessed by analyzing levels of creatine kinase myocardial isozyme (CK-MB) and cardiac troponin T (TnT) before and 6, 12 and 24 h after PCI. Minor myocardial damage was defined as TnT elevation to >0.01 ng/ml. Frequency of minor myocardial damage was 14.2% in Group A and 47.6% in Group B (p=0.043). CK-MB was above the upper limit of normal (ULN) in 19% of Group A and 33.3% of Group B (p=0.44), and CK-MB was >3×ULN in 9.5% of Group A and 19% of Group B (p=0.66). Conclusions Intensive lipid-lowering therapy before PCI reduces minor myocardial damage during PCI with stenting compared with moderate lipid-lowering therapy.
社団法人日本循環器学会の論文
2007-07-20