We read with interest the Nafasi et al.Citation1 study reporting that the use of a single reloading dose (80 mg) of atorvastatin within 24 h prior to elective percutaneous coronary intervention (PCI) significantly decreased periprocedural myocardial infarction (MI) occurrence, independently of preoperative low density lipoprotein cholesterol levels. High dose statin preloading was previously shown to reduce major adverse events after PCI; most studies included statin-naïve populationsCitation2,Citation3. Thus, the present finding is of significant clinical importance as several patients undergoing PCI are already on statins and/or other lipid-lowering drugs, as stated by Nafasi et al.Citation1.
Apart from cardiac procedures, perioperative statin treatment was proven beneficial in patients undergoing vascular surgery or endovascular procedures (e.g. carotid endarterectomy, open infrarenal abdominal aortic aneurysm surgery, endovascular abdominal aortic aneurysm repair, lower limb revascularization and infrainguinal bypass graft procedures)Citation4,Citation5. Furthermore, statin loading was associated not only with improved cardiovascular outcomes but also with reduced hospitalization rates, costs and contrast-induced nephropathyCitation4,Citation6. In this context, the authors should mention if there were any changes in renal function parameters following the intervention.
Abnormal body mass index (<18.5 or ≥40 kg/m2) and metabolic syndrome may be linked to increased peri- or post-procedural worse PCI outcomesCitation7,Citation8. Therefore, it would be useful if the authors could provide data on these parameters.
Declaration of financial/other relationships
This letter was written independently; no company or institution supported the authors financially or by providing a professional writer. N.K. has given talks and attended conferences sponsored by Novartis, Pfizer, MSD and AstraZeneca. A.K. has given talks and attended conferences sponsored by Menarini, AstraZeneca, Novartis and Pfizer. V.G.A. has no interests to declare.
References
- Nafasi L, Rahmani R, Shafiee A, et al. High reloading dose of atorvastatin prior to percutaneous coronary intervention can reduce periprocedural myocardial infarction. Curr Med Res Opin 2013 Aug 19 [Epub ahead of print]. doi: 10.1185/03007995.2013.834249
- Athyros VG, Tziomalos K, Florentin M, et al. Statin loading in patients undergoing percutaneous coronary intervention for acute coronary syndromes: a new pleiotropic effect? Curr Med Res Opin 2010;26:839-42
- Hao PP, Chen YG, Wang JL, et al. Meta-analysis of the role of high-dose statins administered prior to percutaneous coronary intervention in reducing major adverse cardiac events in patients with coronary artery disease. Clin Exp Pharmacol Physiol 2010;37:496-500
- Paraskevas KI, Veith FJ, Liapis CD, et al. Perioperative/periprocedural effects of statin treatment for patients undergoing vascular surgery or endovascular procedures: an update. Curr Vasc Pharmacol 2013;11:112-20
- Paraskevas KI, Giannoukas AD, Mikhailidis DP. Statins and infrainguinal vascular bypass procedures. Curr Vasc Pharmacol 2013;11:51-7
- Li Y, Liu Y, Fu L, et al. Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials. PLoS One 2012;7:e34450
- Byrne J, Spence MS, Fretz E, et al. Body mass index, periprocedural bleeding, and outcome following percutaneous coronary intervention (from the British Columbia Cardiac Registry). Am J Cardiol 2009;103:507-11
- Goyal SN, Bharti S, Krishnamurthy B, et al. Impact of metabolic syndrome on re-stenosis development: role of drug-eluting stents. Diab Vasc Dis Res 2012;9:177-88