The beneficial effect of statin pretreatment in patients undergoing percutaneous coronary intervention – conclusions from ARMYDA-ACS and ARMYDA-RECAPTURE randomized trials Review article

Abstract

PCI-induced injury and inflammation are associated with increased incidence of adverse cardiac events following intervention. Attenuation of those detrimental effects is a key issue in cardiovascular medicine. Several observational studies have demonstrated beneficial effect of statins administered in the setting of PCI. The acute cardioprotective actions of statin therapy initiated prior to intervention is probably due to its pleiotropic effects. The original ARMYDA trial was the first to demonstrate that pretreatment with atorvastatin decreases the incidence of myocardial injury during coronary intervention in statin-naive individuals; however those study enrolled only patents with stable CHD. The aim of the subsequent ARMYDA-ACS trial was to assess whether the acute loading with high-dose atorvastatin improves clinical outcome in individuals with acute coronary syndrome (ACS) treated with PCI. This strategy also proved beneficial as it was associated with an 88% risk reduction of cardiac events at 1 month versus placebo. Considering the large proportion of patients undergoing PCI while on chronic statin therapy, it was unknown whether that group would also benefit from additional loading dose of the regimen. That issue was addressed in the recently published ARMYDA-RECAPTURE study. Reloading with a high dose of atorvastatin before PCI improved clinical outcome in patients already receiving statin therapy; it was associated with a 50% reduction of MACE at 30 days in the treated arm which was primarily driven by a 2.4-fold decrease of the incidence of periprocedural MI. These findings indicate the early cardioprotective effect of acute statin treatment and thus may support a strategy of routine loading with high-dose atorvastatin before PCI even in the background of chronic therapy.