High Dose Statin as Upstream Therapy and the Frequency of Slow-Flow Phenomenon in Patients Undergoing Primary PCI or Immediate Invasive Therapy
Article Sidebar
Main Article Content
Abstract
Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, necessitating effective treatment strategies. High-dose statin therapy has emerged as a potentially superior approach to improving coronary blood flow and reducing the slow-flow phenomenon, a common complication following percutaneous coronary intervention (PCI), compared to standard-dose statin therapy.
Objective: This study aimed to evaluate the efficacy of high-dose statin therapy as an upstream treatment in enhancing coronary blood flow and reducing the incidence of the slow-flow phenomenon in patients undergoing primary PCI or immediate invasive therapy for acute myocardial infarction (AMI).
Methods: In a prospective observational study conducted between February 2023 and January 2024, 95 patients with AMI scheduled for primary PCI or urgent treatment were enrolled and divided into two groups: high-dose statin (n=48) and standard-dose statin (n=47). Group A received high-dose atorvastatin before PCI, while Group B was given the standard statin dosage. Baseline characteristics, clinical parameters, coronary angiography findings, and adverse events were recorded. The primary outcome was the incidence of the slow-flow phenomenon, assessed using Thrombolysis in Myocardial Infarction (TIMI) flow grades. Statistical analysis was performed using SPSS version 25.
Results: The high-dose statin group showed a significant reduction in the incidence of the slow-flow phenomenon post-PCI (10.4% in Group A vs. 31.9% in Group B, p=0.014) and improved TIMI flow grades. No significant differences were found in baseline characteristics or clinical parameters between the groups. Adverse events were comparable between both groups.
Conclusion: High-dose statin therapy prior to PCI significantly reduces the slow-flow phenomenon and improves coronary blood flow in patients with AMI, supporting its use as an effective upstream therapy in CAD management. Further large-scale studies are warranted to confirm these findings and explore the long-term benefits of high-dose statin therapy in diverse populations.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Isiozor NM, Kunutsor SK, Voutilainen A, Kurl S, Kauhanen J, Laukkanen JA. Ideal cardiovascular health and risk of acute myocardial infarction among Finnish men. Atherosclerosis. 2019 Oct;289:126-31.
Kandan SR, Johnson TW. Management of percutaneous coronary intervention complications. Heart. 2018 May 14.
Noc M, Fajadet J, Lassen JF, Kala P, MacCarthy P, Olivecrona GK, Windecker S, Spaulding C. Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)/stent for life (SFL) groups. EuroIntervention. 2014 May;10(1):31-7.
Lee CH, Tse HF. Microvascular obstruction after percutaneous coronary intervention. Catheter Cardiovasc Interv. 2010 Feb 15;75(3):369-77.
Singh S, Kothari SS, Bahl VK. Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J. 2004 Nov;56(6):613-7.
Galasso G, Schiekofer S, D’Anna C, Gioia GD, Piccolo R, Niglio T, Rosa RD, Strisciuglio T, Cirillo P, Piscione F, Trimarco B. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives. Angiology. 2014 Mar;65(3):180-9.
Konijnenberg LS, Damman P, Duncker DJ, Kloner RA, Nijveldt R, Van Geuns RJ, Berry C, Riksen NP, Escaned J, van Royen N. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovasc Res. 2020 Mar 1;116(4):787-805.
Severino P, D’Amato A, Pucci M, Infusino F, Adamo F, Birtolo LI, Netti L, Montefusco G, Chimenti C, Lavalle C, Maestrini V. Ischemic heart disease pathophysiology paradigms overview: from plaque activation to microvascular dysfunction. Int J Mol Sci. 2020 Oct 30;21(21):8118.
Wierzbicki AS, Poston R, Ferro A. The lipid and non-lipid effects of statins. Pharmacol Ther. 2003 Jul 1;99(1):95-112.
Endres M. Statins: potential new indications in inflammatory conditions. Atherosclerosis Supplements. 2006 Apr;7(1):31-5.
Koskinas K, Mach F, Räber L. Lipid-lowering therapy and percutaneous coronary interventions: Lipid-lowering therapy and PCI. EuroIntervention. 2021 Apr;16(17):1389.
Kumar J, O’Connor CT, Kumar R, Arnous SK, Kiernan TJ. Coronary no-reflow in the modern era: a review of advances in diagnostic techniques and contemporary management. Expert Rev Cardiovasc Ther. 2019 Aug;17(8):605-23.
Ray KK, Cannon CP, McCabe CH, Cairns R, Tonkin AM, Sacks FM, Jackson G, Braunwald E; PROVE IT-TIMI 22 Investigators. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2005 Oct 18;46(8):1405-10.
Patel TN, Shishehbor MH, Bhatt DL. A review of high-dose statin therapy: targeting cholesterol and inflammation in atherosclerosis. Eur Heart J. 2007 Mar 1;28(6):664-72.
Ramjee V, Jacobson T. Intensifying statin therapy to maximize cardiovascular risk reduction: is 50 the new 70? Goals are getting old. Clin Lipidol Metab Disord. 2011 Apr 1;6(2).
Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol. 2006 Aug 1;48(3):438-45.
Pastori D, Baratta F, Di Rocco A, Farcomeni A, Del Ben M, Angelico F, Violi F, Pignatelli P, Lip GY. Statin use and mortality in atrial fibrillation: A systematic review and meta-analysis of 100,287 patients. Pharmacol Res. 2021 Mar 1;165:105418.
Kanthallu SN, Sathyamurthy I. Coronary slow flow/no-reflow: Revisited. J Indian Coll Cardiol. 2022;12(1):8-13.
Greco A, Finocchiaro S, Angiolillo DJ, Capodanno D. Advances in the available pharmacotherapy for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Expert Opin Pharmacother. 2023 Mar;24(4):453-71.
Wang X, Guo R, Guo Y, Guo Q, Yan Y, Gong W, Zheng W, Wang H, Xu L, Ai H, Que B. Rationale and design of the RESTORE trial: a multicenter, randomized, double-blinded, parallel-group, placebo-controlled trial to evaluate the effect of Shenfu injection on myocardial injury in STEMI patients after primary PCI. American Heart Journal. 2023 Jun 1;260:9-17.