Efficacy of Atorvastatin Reload in Patients on Chronic Statin Therapy Undergoing Percutaneous Coronary Intervention
Open accessAbstract
Objectives This study was designed to investigate whether an acute atorvastatin reload before percutaneous coronary intervention (PCI) protects patients receiving chronic statin therapy from periprocedural myocardial damage.Background Previous ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) studies demonstrated that short-term pre-treatment with atorvastatin reduces myocardial infarction during PCI in statin-naïve patients with both stable angina and acute coronary syndromes.Methods A total of 383 patients (age 66 +/- 10 years, 305 men) with stable angina (53%) or non-ST-segment elevation acute coronary syndromes (47%) and chronic statin therapy (55% atorvastatin) undergoing PCI were randomized to atorvastatin reload (80 mg 12 h before intervention, with a further 40-mg pre-procedural dose [n = 192]) or placebo (n = 191). All patients received long-term atorvastatin treatment thereafter (40 mg/day). The primary end point was 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unplanned revascularization).Results The primary end point occurred in 3.7% of patients treated with atorvastatin reload and in 9.4% in the placebo arm (p = 0.037); this difference was mostly driven by reduction in periprocedural myocardial infarction. There was lower incidence of post-procedural creatine kinase-myocardial band and troponin-I elevation greater than the upper limit of normal in the atorvastatin arm (13% vs. 24%, p = 0.017, and 37% vs. 49%, p = 0.021, respectively). Multivariable analysis identified atorvastatin reload as a predictor of decreased risk of 30-day incidence of major adverse cardiac events (odds ratio: 0.50, 95% confidence interval: 0.20 to 0.80; p = 0.039), mainly in patients with acute coronary syndromes (82% relative risk reduction; p = 0.027).Conclusions The ARMYDA-RECAPTURE trial suggests that reloading with high-dose atorvastatin improves the clinical outcome of patients on chronic statin therapy undergoing PCI. These findings may support a strategy of routine reload with high-dose atorvastatin early before intervention even in the background of chronic therapy.
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The ARMYDA trial showed that reloading with high-dose atorvastatin reduces periprocedural MI frequency even in patients on chronic statin therapy undergoing PCI for stable angina or low-intermediate risk ACS.
“More recently, the Atorvastatin for Reduction of Myocardial Damage during Angioplasty (ARMYDA) 179 trial demonstrated that reloading with high dose atorvastatin reduces the frequency of periprocedural MI, even in patients receiving chronic statin therapy undergoing PCI for management of stable angina or low -intermediate risk ACS.”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [179]
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- Authors
- Di Sciascio, G., Patti, G., Pasceri, V., Gaspardone, A., Colonna, G., & Montinaro, A.
- Affiliations
- Università Campus Bio-Medico (IT)
- Ospedale San Filippo Neri (IT)
- St. Eugenio Hospital (IT)
- Ospedale Vito Fazzi (IT)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 54
- Issue
- 6
- Pages
- 558-565
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W201549064
- Cited by
- 315
- References
- 33
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 5 · 2020: 7 · 2019: 13 · 2018: 11 · 2017: 20 · 2016: 17 · 2015: 27 · 2014: 23 · 2013: 26 · 2012: 25
- FWCI
- 44.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- atorvastatin, statin therapy, percutaneous coronary intervention, periprocedural myocardial infarction, major adverse cardiac events, acute coronary syndrome, stable angina, troponin I, creatine kinase myocardial band, revascularization
- MeSH terms
- Atorvastatin, Aged, Combined Modality Therapy, Coronary Artery Disease, Double-Blind Method, Female, Heptanoic Acids, Humans, Male, Middle Aged, Myocardial Infarction, Pyrroles, Angioplasty, Balloon, Coronary, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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