The impact of pravastatin pre-treatment on periprocedural microcirculatory damage in patients undergoing percutaneous coronary intervention

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

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

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).

Original languageEnglish
Pages (from-to)513-520
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume4
Issue number5
DOIs
StatePublished - May 2011

Keywords

  • angioplasty
  • drugs
  • microcirculation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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