Efficacy of chronic high-dose statin therapy in procedural myocardial injury and long-term outcomes in patients undergoing rotablational atherectomy

Abstract

Background: Periprocedural myocardial injury remains the most common complication associated with rotational atherectomy (ROTA). Furthermore, previous studies have demonstrated that even a small elevation of cardiac enzymes is associated with higher risk of mortality during follow-up. Otherwise, pre-treatment with high-dose statins reduced the risk of procedural myocardial injury after coronary intervention. This study was to verify whether chronic high-dose statin before PCI might protect periprocedural myocardial damage and improve long-term outcomes after ROTA. Methods: We prospectively studied 476 patients (age 67.4±9.2 years, 398 men) with chronic stable angina who underwent ROTA. The patients were divided into three groups according to use of statin; 1) no statin treatment before procedure (195 patients), 2) standard dose statin (189 patients), and 3) high-dose statin (92 patients). The primary end point was periprocedual CPK and hs-CRP and long-term outcomes (death and ACS). Results: There were no significant differences among 3 groups in clinical and angiographic background. Markers of myocardial injury of the all groups were elevated after ROTA; however, the high-dose statin arm had significantly lower periprocedural levels of CPK and hs-CRP than standard-statin group and no-statin group. In the no statin group, 8% of patients had CK increases >3 times the upper limit of normal compared with 2% in the high-dose statin group (p = 0.02). By logistic regression analysis, the independent predictors of CPK elevation >3 times after ROTA were statin pre-treatment (OR=0.53; 95% CI=0.13-0.86; p=0.02). The patients with high statin group had lower events rate than other groups. Multivariable analysis identified high dose statin as a predictor of decreased adverse events (HR: 0.46, 95% CI: 0.28 to 0.74; p= 0.001). Conclusions: Pretreatment with high-dose statin significantly reduces procedural myocardial injury and improves the long-term prognosis in patients with stable angina undergoing ROTA.