Effect of low dose statins in secondary prevention in patients undergoing percutaneous coronary interventions

Abstract

Introduction: In addition to invasive coronary revascularization procedures (PCI) in the treatment of ischemic heart disease indication of a systemic therapy could prevent recurrent events. Treatment with statins significantly reduces long-term occurrence of major clinical cardiovascular events post-PCI. The initiation of statin treatment as early as possible and the maintenance of a good adherence to statin therapy would lead to a more favorable clinical course in post-PCI period. The aim of this study was to evaluate the effect of low dose statins on the incidence of cardiovascular events (myocardial infarction, stroke, recurrent angina and instent restenosis) in patients undergoing percutaneous coronary interventions with stent implantation. Materials and methods: We conducted a retrospective study that included 95 patients after coronary angioplasty with stenting. According to statin therapy these patients were divided into two groups: 1st group - without statin treatment in post-PCI period (32 patients, mean age o f 59 ± 1.53 years) and 2nd group - patients with statin treatment in post-PCI period (63 patients, mean age o f 58 ± 1.09 years). 67.7% o f patients in 2nd group received simvastatin (10-20 mg/d, the mean dose - 16.5 mg/d), 25.4% - atorvastatin (10-20 mg/d, the mean dose - 14.9 mg/d) and 6.9% - other statins (pravastatin, lovastatin, fluvastatin). The high percentage of patients that were not receiving statins is explained by low medication compliance. The incidence of cardiovascular events was assessed at 6.51 ± 0 .1 5 months post-PCI. Results: 12.5% patients in the no-statin group experienced at 6 months post-PCI a major adverse cardiovascular event (3 patients - stroke and 1 patient - acute myocardial infarction) vs. 0% patients in the statin group (p<0.05). The incidence of cardiovascular composite endpoint, which included myocardial infarction, stroke, progression of angina and repeat revascularization, also was higher in 1st group vs. 2nd group - 62.5% (20) vs. 38.1% (24), p<0.05. Administration of low dose statins did not influence at 6 months post-PCI the need for repeat coronary angiography (18.6% (6) patients in 1st group vs. 15.9% (10) in 2nd group, p>0.05), repeat revascularization (15.6% (5) vs. 15.6% (10), p>0.05) and target lesion revascularization (12.5% (4) vs. 7.9% (5), p>0.05). Clinical instent restenosis was determined in 12.5% (4) patients in the no-statin group and 7.9% (5) patients in the statin group (p>0.05).In addition, there were no differences in total cholesterol (CT), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels between these two groups, irrespective o f statins treatment: 1st group - CT - 5.3 ± 0.21 mmol/1, HDL-C - 1.22 ± 0.03 mmol/1, LDL-C - 2.96 ± 0.16 mmol/1 and 2nd group - CT - 5.44 ±0.16 mmol/1, HDL-C - 1.26 ± 0.02 mmol/1, LDL-C - 3.19 ± 0.14 mmol/1 (p>0.05). Conclusion: This study suggests that low dose statins have a favorable effect on clinical outcome in patients after percutaneous coronary interventions. Therefore statin therapy should be administered to all patients undergoing coronary interventional procedures.