07 Oct Chronic Statins Reduce Heart Attack Damage
Medical Research: What is the background for this study? What are the main findings?
Dr. Marenzi: Pre-treatment with statins in patients with stable angina or non-ST-elevation acute coronary syndromes undergoing elective or urgent percutaneous coronary intervention (PCI) has been shown to reduce myocardial injury and to improve clinical outcomes. Conversely, data on a cardio-protective effect of statin pre-treatment in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI are more controversial. In this prospective study, we evaluated infarct size and myocardial salvage by cardiac magnetic resonance imaging in a consecutive cohort of 230 STEMI patients undergoing primary PCI, comparing patients on chronic statin with those without.
Patients on chronic statin therapy showed an almost 40% lower enzymatic (troponin I) peak value, when compared to patients without. In parallel, a 32% smaller infarct size and a 24% higher myocardial salvage were found in the statin group, as compared to those without. In the entire population, no significant association was found between infarct size and LDL-cholesterol levels at hospital admission.
Medical Research: What should clinicians and patients take away from your report?
Dr. Marenzi: The results of the present study demonstrated that chronic statin therapy is associated with smaller infarct size and higher myocardial salvage in STEMI patients undergoing primary PCI, as compared to patients without prior statin therapy. Although the mechanism(s) underlying the cardio-protective effect of statins is still unclear, pleiotropic effects (not related to LDL lowering) seem to be involved. Thus, our study emphasizes an additional positive effect of statins in patients with known coronary artery disease and, particularly, in those at high risk for acute myocardial infarction. Indeed, in case they present with STEMI, chronic statin therapy may play a protective role in addition to myocardial reperfusion, minimizing final infarct size.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Marenzi: Future studies should investigate the potential impact on long-term mortality of statin-associated infarct size reduction and assess whether very early statin administration (in the ambulance) in naïve-statin patients with ongoing STEMI may be associated with an improved clinical outcome.
Myocardial Infarct Size in Patients on Chronic Statin Therapy Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
Marenzi, Giancarlo et al.
American Journal of Cardiology Published Online: October 02, 2015
Giancarlo Marenzi, M.D. (2015). Chronic Statins Reduce Heart Attack Damage