Lopes RD, et al. - Researchers assessed the impact of the timing of a loading dose of atorvastatin before percutaneous coronary intervention (PCI) on 30-day major adverse cardiovascular events (MACE) in patients presenting with acute coronary syndrome (ACS). Findings suggest that periprocedural loading doses of atorvastatin may lower the rate of MACE at 30 days, mainly in patients with ST-segment elevation myocardial infarction. Timing of atorvastatin administration seemed to not have an influence on this beneficial effect.

Methods

• Researchers performed a secondary analysis of a multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites.
• The study enrolled 4,191 patients with ACS intended to be treated with PCI between April 18, 2012 and October 6, 2017.
• Randomization of patients to 2 loading doses of 80 mg of atorvastatin or matching placebo before and 24 hours after a planned PCI was done.
• By protocol, 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication was administered to all patients (regardless of treatment group).
• MACE through 30 days was assessed as the primary outcome; MACE was composed of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization.
• Using Cox regression models adjusting for key baseline characteristics, the association between atorvastatin and MACE was determined in patients undergoing PCI.

Results

• In the overall trial population, PCI was performed on 2,710 (64.7%; 650 women [24.0%]; mean [SD] age, 62 [11.3] years).
• The PCI group showed reduced MACE at 30 days by 28% in correlation with loading atorvastatin (adjusted hazard ratio [HR], 0.72; 95% CI 0.54-0.97; P = .03).
• Loading dose of atorvastatin was administered less than 12 hours before PCI in 2,548 patients (95.3%) (45.1% < 2 hours and 54.3% between 2 and 12 hours).
• No significant interaction between treatment effect and timing of study drug administration was evident.
• Patients with ST-segment elevation myocardial infarction displayed more pronounced treatment effect of loading atorvastatin than patients with non–ST-segment elevation ACS (adjusted HR, 0.59; 95% CI, 0.38-0.92; P = .02; HR, 0.85; 95% CI, 0.58-1.27; P = .43, respectively).