Statins pre PCI

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					Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS – Presented at ACC 2007) Interpretation Among patients with ACS undergoing PCI, pretreatment with atorvastatin 80 mg was associated with a reduction in major adverse cardiac events (MACE) at 30 days compared with placebo, driven exclusively by a reduction in periprocedural MI. Results of the present study are similar to the original ARMYDA study, which also showed a reduction in periprocedural MI with atorvastatin pretreatment but in a low-risk, stable angina, elective PCI population. When feasible, treatment with a loading dose of atorvastatin pre-PCI appears promising. However, the optimal timing of the pretreatment load is unknown, as is the impact of delaying PCI to pretreat with atorvastatin in an ACS population. Pretreatment in the present study was for 12 hours and mean time to PCI was 23 hours, but in an unstable population, time to revascularization is often shorter. While the mechanism of action for the reduction of myocardial injury in the atorvastatin arm is not clear, the authors suggest the antiinflammatory effect of statins may contribute to the reduction. The relative lower increase in CRP post-PCI in the atorvastatin arm supports this potential mechanism of action.

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