Intensive atorvastatin improves endothelial function and decreases ADP-induced platelet aggregation in patients with STEMI undergoing primary PCI: A single-center randomized controlled trial. (1st November 2016) - Xu, Xiaorong
Abstract: Background: Intensive atorvastatin may be beneficial for patients with ST segment elevated myocardial infarction (STEMI). However, its effects on endothelial and residual platelet function remain uninvestigated in these patients. Methods: This single-center single-blinded prospective randomized controlled trial included STEMI patients undergoing PCI, aiming to investigate the acute effects of intensive atorvastatin (40 mg) vs. standard atorvastatin (20 mg) on serum endothelin-1 (ET-1) and ADP-induced platelet clot strength (MA-ADP), which were measured before and after 7 days of atorvastatin treatment respectively. MA-ADP was measured by thromboelastography. The tolerance and safety of intensive atorvastatin therapy in these patients were also observed. Results: A total of 120 patients (60 patients in the intensive group and 60 patients in the standard group) with STEMI, who are undergoing primary PCI, were included into this study (mean age, 63.5 years). Patients from these two groups were matched for baseline characteristics. Atorvastatin did not significantly affect the serum level of LDL-C or CRP in either the standard or intensive group. Furthermore, ET-1 did not significantly change following treatment with atorvastatin in the standard group. However, intensive treatment with atorvastatin significantly reduced ET-1 serum level (0.65 ± 0.38 pmol/L vs. 0.49 ± 0.21 pmol/L, P < 0.05) and achieved a greater reduction of MA-ADP (49.2 ± 12.1 vs. 38.4 ± 17.4 mm, P < 0.05). In addition, although not statistically significant, patients assigned to the intensive group appeared to suffer from less major adverse cardiovascular events. Conclusions: Periprocedural intensive atorvastatin is associated with improved endothelial function and platelet inhibition, and is well-tolerated in STEMI patients undergoing PCI. Highlights: Intensive treatment with atorvastatin significantly reduced ET-1 serum level. Intensive treatment with atorvastatin also achieved a greater reduction of MA-ADP. ET-1 serum levels were positively correlated with MA-ADP after Intensive treatment. Patients in intensive group appeared to suffer from less cardiovascular events.