The Relationship between Loading of a High Dose Atorvastatin and No Reflow in STEMI Patients Undergoing Primary PCI

Abstract

Abstract Background Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing. STEMI is a significant cause of morbidity and mortality in patients with coronary heart disease. Aim of the Work The aim of our study was to assess the impact of high dose atorvastatin loading before primary PCI in patients presenting with acute STEMI on No-reflow and MACE at 1 month follow up. Patients and Methods This is a randomized control clinical trial based at the coronary care units & coronary catheterization lab unit of the cardiology department in Ain Shams University Hospitals. Patients who presented, between April 2021 to October 2021, with STEMI and undergoing primary percutaneous coronary intervention were allocated to the study and divided into 2 groups: Study group: received high intensity statin (80 mg of Atorvastatin) besides guideline recommended therapy before primary PCI, Control group: received guideline recommended therapy before primary PCI. Results Results for age, gender, hypertension, Diabetes and smoking did not show any statistical significance between the control and study groups. There was a statistically significant improvement in study group compared to control group in No-reflow (28% vs 47%) with a P-value of 0.006; primarily derived by improvement in MBG (0-1: 28% vs 43%, 2-3: 72% vs 57%) with a P-value 0.027, and improvement in EF at 24 h after PCI (Mean±SD 48.35 ± 8.78 vs 45.20 ± 7.89) with a P-value of 0.008 and at 1 month follow up (43% vs 20%) with a P-value of 0.039, but it did not have a significant impact on MACE at 1 month follow up. Conclusion Our study concluded that high dose atorvastatin loading before primary PCI resulted in improved post-procedural MBG, no-reflow and Ejection fraction as measured by bi-plane Simpson's method but did not decrease in MACE at 1 month follow up. Based on the results of this study, we highly recommend the routine use of high dose atorvastatin before primary PCI in patients presenting with STEMI. Abbreviations ACS: Acute coronary syndrome; BP: Blood pressure; ECG:. Electrocardiography; ESC: European society of cardiology; EF: Ejection fraction; MACE: Major adverse cardiac events; MBG: Myocardial blush grade; MRI: Magnetic resonance imaging; PCI: Percutaneous coronary intervention; SPSS: Statistical Package for Social Science; STEMI: ST segment elevation myocardial infarction; STR: ST segment resolution; TIMI: Thrombolysis in myocardial infarction