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Therapeutic Advances in Cardiovascular Disease
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Aggressive statin therapy in multicenter and effectiveness for the reduction of intra-myocardial damage caused by non-ST elevation acute coronary syndrome: AMERICA study

Hidehiko Hara

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan, harahide{at}aol.com

Masato Nakamura

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Itaru Yokouchi

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Keiko Kimura

Division of Geriatrics, Montefiore Medical Center, Bronx, NY, USA

Naohiko Nemoto

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Shingo Ito

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Tsuyoshi Ono

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Hideki Itaya

Division of Cardiology, Nissan Tamagawa Hospital, Tokyo, Japan

Masanori Shiba

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Masamichi Wada

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Raisuke Iijima

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Masaya Yamamoto

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Masato Yamamoto

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Hisao Hara

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Takuro Takagi

Division of Cardiology, Toshiba Hospital, Tokyo, Japan

Toshiyuki Asahara

Division of Cardiology, Tokyo Rosai Hospital, Tokyo, Japan

Kazuhisa Mitsuo

Division of Cardiology, Nissan Tamagawa Hospital, Tokyo, Japan

Nobuyuki Kobayashi

Division of Cardiology, Ota General Hospital, Ota, Japan

Kaoru Sugi

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

Background: While preprocedural statin treatment for acute coronary syndrome (ACS) is widely regarded as beneficial, there has been no prospective randomized multicenter trial of patients with non-ST elevation ACS in the Japanese population to examine the efficacy of preprocedural aggressive statin use. The aim of this study was to confirm this effect by prospective randomized multicenter design.

Methods: Fifty patients who presented with non-ST elevation ACS were enrolled, and randomly assigned to aggressive statin administration before percutaneous coronary intervention (PCI). Troponin-T (TnT), creatine phosphokinase (CK), CK-myocardial band (CK-MB), high-sense C-reactive protein (hs-CRP), and brain natriuretic peptide (BNP) were measured at baseline and/ or after procedure.

Results: Three days after PCI, the statin group had significantly less CK elevation compared with the nonstatin group (84±17 IU/l versus 180±68 IU/l, respectively, p = 0.02). CK-MB elevation also tended to be lower in the statin group than in the nonstatin group (3.2±1.9 versus. 7.0±3.0, respectively, p = 0.07), as was BNP level (3.2±1.9 versus 7.0±3.0 pg/ml, respectively, p = 0.07). The change of serum LDL cholesterol was significantly correlated with CK (p = 0.01) and TnT (p = 0.02) at 1 day after PCI.

Conclusions: Aggressive statin usage before PCI to Japanese patients with non-ST elevation ACS appears to reduce myocardial damage after procedure. The degree of serum lipid level reduction may reflect the vulnerability of atheromatous plaques that could cause cardiac damage after PCI.

Key Words: coronary artery disease • percutaneous coronary intervention (PCI) • statin

This version was published on October 1, 2009

Therapeutic Advances in Cardiovascular Disease, Vol. 3, No. 5, 357-365 (2009)
DOI: 10.1177/1753944709338893
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