statins pretreatment before PCI

[Dr.Vad]

Уважаемые коллеги,

Попалась на глаза недавняя статья от польских коллег (тезисы ниже): впечатляет, что такое несложное лечение улучшает отдаленные результаты в разы. Результат отсутствия рандомизации, плацебы и тп?

Kardiol Pol. 2006 Dec;64(12):1357-1362.
Effects of high-dose statin administered prior to coronary angioplasty on the incidence of cardiac events in patients with acute coronary syndrome.
Chyrchel M, и соавт.

Introduction: Statins given after acute coronary syndrome without ST elevation (NSTE-ACS) reduce the incidence of major adverse cardiac events (MACE) in long-term follow-up. Aim: To evaluate the effects of high-dose statin administered in patients with NSTE ACS and increased CRP level prior to percutaneous coronary intervention (PCI) on the incidence of MACE in long-term follow-up. Methods: The study involved 140 consecutive patients with NSTE ACS and increased CRP level at baseline. Patients from group A (n=54) did not receive statin before PCI, whereas subjects in group B (n=86) were given 80 mg of atorvastatin. Patients in both groups received typical cardiological therapy including aspirin, thienopyridine and low molecular weight heparin. After PCI all patients received 40 mg of atorvastatin. Incidence of MACE (death, myocardial infarction (MI), re-PCI) during long-term followup was evaluated in both groups. Results: Study groups did not differ with respect to demographic parameters and rate of ischaemic heart disease risk factors. Also, no differences occurred regarding CRP level (group A vs. B: hsCRP 10.8+/-1.8 mg/l vs. 8.2+/-2.8 mg/l; p=NS) and TIMI Risk Score (group A vs. B: 4.3+/-0.71 vs. 4.37+/-0.79; p=NS). During long-term follow-up the incidence of MI (9.25% vs. 1.2%, p=0.03), composite endpoint: death + MI (14.8% vs. 2.32%, p=0.013) and death + MI + re PCI (25.9% vs. 8.1%, p=0.006) was significantly higher in group A than group B. Conclusions: Administration of high-dose statin in NSTE ACS patients before PCI was associated with significant reduction of MACE in long-term follow-up.

Конечно, есть наблюдения (ниже), что наличие в анамнезе приема статинов перед кардиохирургическими вмешательствами ассоциируется с улучшенным прогнозом, но вот что бы так, разок назначил загрузочную дозу аторвастатина 80 перед операцией (прямо как клопидогреля 300-600) и все ОК?

Clark LL, и соавт.
Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study.
J Thorac Cardiovasc Surg. 2006 Mar;131(3):679-85.

Pascual DA, и соавт.
Preoperative statin therapy and troponin T predict early complications of coronary artery surgery.
Ann Thorac Surg. 2006 Jan;81(1):78-83

[Dr.Vad]

продолжение темы:

J Am Coll Cardiol. 2007 Mar 27;49(12):1272-8.

Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial.

Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti D, Sardella G, Montinaro A, Di Sciascio G.

Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.

OBJECTIVES: This study sought to investigate potential protective effects of atorvastatin in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). BACKGROUND: Randomized studies have shown that pretreatment with atorvastatin may reduce periprocedural myocardial infarction in patients with stable angina during elective PCI; however, this therapy has not been tested in patients with ACS. METHODS: A total of 171 patients with non-ST-segment elevation ACS were randomized to pretreatment with atorvastatin (80 mg 12 h before PCI, with a further 40-mg preprocedure dose [n = 86]) or placebo (n = 85). All patients were given a clopidogrel 600-mg loading dose. All patients received long-term atorvastatin treatment thereafter (40 mg/day). The main end point of the trial was a 30-day incidence of major adverse cardiac events (death, myocardial infarction, or unplanned revascularization). RESULTS: The primary end point occurred in 5% of patients in the atorvastatin arm and in 17% of those in the placebo arm (p = 0.01); this difference was mostly driven by reduction of myocardial infarction incidence (5% vs. 15%; p = 0.04). Postprocedural elevation of creatine kinase-MB and troponin-I was also significantly lower in the atorvastatin group (7% vs. 27%, p = 0.001 and 41% vs. 58%, p = 0.039, respectively). At multivariable analysis, pretreatment with atorvastatin conferred an 88% risk reduction of 30-day major adverse cardiac events (odds ratio 0.12, 95% confidence interval 0.05 to 0.50; p = 0.004). CONCLUSIONS: The ARMYDA-ACS trial indicates that even short-term pretreatment with atorvastatin may improve outcomes in patients with ACS undergoing early invasive strategy. These findings may support routine use of high-dose statins before intervention in patients with ACS.

[Gilarov]

Это 40 мг приема аторвы все улучшает . А назначение статинов перед операцией уменьшает еще частоту послеоперационной ФП

[Dr.Vad]

Дык, в том то и дело, что абсолютно все получали аторву40 после операции:

Eligible patients (n = 191) were randomized to receive placebo or atorvastatin (80-mg loading dose given a mean of 12 h before coronary angiography, with a further 40-mg dose approximately 2 h before the procedure)...

According to protocol, patients were pretreated before intervention with aspirin (100 mg/day) and clopidogrel (600-mg loading dose at least 3 h before the procedure)...After PCI, aspirin (100 mg/day) was continued indefinitely, whereas clopidogrel (75 mg/day) was administered for at least 6 months; after intervention, all patients were treated with atorvastatin (40 mg/day) irrespective of the initial randomization assignment.

[alex_md]

Statins make everything better. You almost need to do a study to find out who does not need statins.

[Dr.]

Сообщение от alex_md

Statins make everything better. You almost need to do a study to find out who does not need statins.

Подумал СЛОВО В СЛОВО то же самое, только на русском

[Igor73]

И при ХПН+сепсис тоже неплохо..
Statin use is strongly associated with a reduced risk of hospitalization for sepsis in patients with chronic kidney disease receiving dialysis, according to a prospective observational study.
The study, published in JAMA, was based on about 1000 people receiving outpatient dialysis, 14% of whom were on statins. During mean follow-up of 3.4 years, the risk of hospitalization for sepsis was 62% lower among statin users, after adjustment for comorbidities and other factors.
The authors said statins may minimize the risk for sepsis in patients with infections by regulating the immune response to infection.
[Ссылки доступны только зарегистрированным пользователям ]

[Tim Hunter]

Сообщение от Igor73

И при ХПН+сепсис тоже неплохо..

Только не при, а до.

[Dr.Vad]

Нынешняя ситуация по статинам и сепсису следующая:

Ann Pharmacother. 2007 Mar 27;
The Role of Statin Therapy in Sepsis.
Chua D, Tsang RS, Kuo IF.
St. Paul's Hospital, Vancouver, BC, Canada; Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver.

OBJECTIVE: To systematically review the evidence evaluating the role of statin therapy in sepsis. DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched (1980-January 2007) for English-language clinical trials that evaluated the use of statins and the development and treatment of sepsis in human subjects. Search terms included statin, HMG-CoA reductase inhibitor, bacteremia, sepsis, septic shock, septicemia, and severe sepsis. In addition, pertinent references from identified articles were obtained. STUDY SELECTION AND DATA EXTRACTION: Only clinical trials with primary efficacy outcomes of mortality, incidence of sepsis, and severe sepsis were included. DATA SYNTHESIS: Seven retrospective and 2 prospective cohort studies were included in this review. One was excluded because the patient population was not experiencing sepsis. Three studies demonstrated a reduced mortality with statin use while 2 other studies did not demonstrate this mortality benefit. One study suggested increased mortality with statin use in sepsis. Three studies showed a reduced incidence of development of sepsis or sepsis-related outcomes, while one study did not. The observational and retrospective nature of these studies and the higher rate of cardiovascular comorbidities in the statin groups may have allowed for a confounding influence. The conflicting results and heterogeneity between the studies makes the observed association between statin use and incidence of sepsis and sepsis-related mortality inconclusive. The clinical benefit of statin therapy in sepsis remains to be determined. CONCLUSIONS: There is an association between statin use and a lower incidence of sepsis and sepsis-related mortality. However, a causal relationship between statin use and reduced sepsis-related mortality has not yet been established. Currently, statins cannot be recommended for sepsis prevention or treatment until controlled trials are performed.