Atorvastatin Loading Dose May Improve PCI Outcomes in ACS

By Reuters Staff

NEW YORK (Reuters Health) - Periprocedural loading doses of atorvastatin are associated with improved outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), according to a subgroup analysis of SECURE-PCI trial data.

In the overall SECURE-PCI trial, loading doses of atorvastatin did not improve clinical outcomes in the overall population of patients with ACS, but a potential benefit was identified in patients who subsequently underwent PCI.

Dr. Renato D. Lopes from Brazilian Clinical Research Institute, in Sao Paulo, Brazil, and Duke Clinical Research Institute, in Durham, North Carolina, and colleagues investigated whether periprocedural loading doses of atorvastatin were associated with decreased 30-day major adverse cardiovascular events (MACE) in patients with ACS undergoing PCI in a prespecified subgroup analysis of 2,710 SECURE-PCI participants.

A loading dose of atorvastatin was associated with a significant 28% reduction in MACE at 30 days among patients who underwent PCI (P=0.03), compared with a nonsignificant 44% increased risk among patients who did not undergo PCI, the team reports in JAMA Cardiology, online September 24.

The treatment effect of loading atorvastatin appeared to be more pronounced in patients with ST-elevation myocardial infarction (STEMI) - a significant 41% reduction - than in patients with non-ST-elevation ACS - a nonsignificant 15% reduction.

In the overall PCI population, an atorvastatin loading dose was also associated with a significant 32% reduction in the risk of heart attack at 30 days.

The clinical benefit of an atorvastatin loading dose in the PCI group of patients was consistent regardless of the timing of its administration, including within two hours before PCI.

There was no treatment effect of loading atorvastatin (versus placebo) in patients undergoing coronary artery bypass grafting or medical management.

"Considering the safety of statins, treating patients with ACS, in particular with STEMI, with loading doses of statin as early as possible before PCI is a reasonable approach that may improve short-term clinical outcomes," the researchers conclude.

Dr. Lopes did not respond to a request for comments.

Three of the 14 authors had various relationships with Pfizer Inc. outside of the current work.

SOURCE: https://bit.ly/2NHOfzR

JAMA Cardiol 2018.

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