Comparison of the efficacy of periprocedural rosuvastatin versus atorvastatin treatment in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Background: We investigated whether periprocedural intensive rosuvastatin therapy, compared with atorvastatin treatment, could lead to a further improvement of myocardial reperfusion among patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary PCI. Methods: In total, 435 patients with acute STEMI undergoing primary PCI were randomly assigned to receive no statin (Group I, n=149) or a loading dose of 80mg atorvastatin (Group II, n=144) or 40mg rosuvastatin (Group III, n=142) before the procedure. After PCI, Group I patients were treated with atorvastatin 20mg/day. For those in Group II or Group III, atorvastatin 40mg/day or rosuvastatin 20mg/day was given for 5 days, followed by atorvastatin 20mg/day or rosuvastatin 10mg/day, respectively, until the end of study. The primary endpoint was the corrected Thrombolysis In Myocardial Infarction (TIMI) Frame Count (cTFC) of Infarct-Related Artery (IRA) immediately after revascularization. Secondary endpoints included mean ST-segment Resolution (STR), enzymatic infarct size, Left Ventricular (LV) function, and Major Adverse Cardiac Event (MACE) free survival at 30-day follow-up. Results: The primary endpoint was significantly improved in statin-pretreatment groups after stent implantation (Group I: 26.4±14.2; Group II: 22.3±10.2; Group III 22.8±9.4, p=0.004). Striking differences were detected when comparisons using Fisher's Least Significant Difference (LSD) method were made between Group I and Group II (p=0.002) or Group III (p=0.007), respectively, while not between Group II and Group III (P=0.74). Similar differences were also achieved in mean STR (p=0.009), but not in enzymatic infarct size, LV Ejection Fraction (EF) and MACE free survival at 30-day follow-up among groups. The serum level of high-sensitivity C-reactive protein (hsCRP) 24h to 72h after primary PCI was dramatically lower in Groups II and III than in Group I (p<0.01). The incidence of new-onset liver or renal dysfunction did not significantly differ among groups. Conclusions: Early and short-term intensive treatment with atorvastatin or rosuvastatin is equally effective in improving significantly myocardial reperfusion measured by cTFC and STR after primary PCI, but does not influence 30-day clinical outcomes. The long-term beneficial effects of periprocedural intensive statin therapy need further studies.