Pre-Therapy With Statins in Percutaneous Coronary Interventions

Abstract

Statins present a number of beneficial effects on endothelial function and atherosclerotic plaque, modulating oxidative stress and inflammation. The benefits of long-term statin treatment in the entire spectrum of atherosclerotic vascular disease can largely be explained by its cholesterol-lowering effects and the associated reduction of the progression of atherosclerosis. The short-term benefits of statins use are most likely due to their non-lipid, pleiotropic effects. Myocardial injury during percutaneous coronary intervention (PCI) occurs in 10-40% of cases and is often characterized by a slight increase in the markers of myocardial necrosis, sometimes without symptoms, electrocardiographic changes or impairment of cardiac function. Periprocedural myocardial infarction is associated with a worse outcome on long term follow-up. Several randomized trials have suggested a beneficial effect of pre-treatment with statins in the outcome of the procedure. Myocardial protection by statin pre-therapy in PCI has been studied in several trials published over the last decade. The mechanisms underlying the beneficial pleiotropic effects of statins may be an anti-inflammatory action reducing myocardial injury necrosis due to microembolization, an improvement in endothelial function on microcirculation, and direct myocardial protection. This article reviews the major randomized trials which have studied the use of statins as pre-treatment in PCI and explores future perspectives. Key words: statins, percutaneous coronary intervention, acute coronary syndromes