Stable Angina Clinical Trial
Official title:
Atorvastatin for Reduction of Myocardial Damage During Angiography and Its Mechanism Associated With IMR
The purpose of this study is to determine whether preoperative loading dose atorvastatin can prevent perioperative myocardial infarction during angiography and main adverse cardiac events 1 month after operation in stable angina, unstable angina and acute non-ST-segment elevation myocardial infarction patients undergoing elective coronary angiography and PCI, and determine whether its mechanisms are associated with microcirculation resistance.
With 20 years of popularity of the clinical applications of percutaneous coronary
intervention (PCI), increasing attention has been paid to postoperative myocardial injury
(MI) after PCI. NAPLES II1 and ARMYDA2Studies have shown that loading dose statin therapy
before PCI for ACS patients can reduce perioperative myocardial infarction and major adverse
cardiac events (MACE) and mortality 1 year after PCI. The core mechanism about the effects
of statins on the clinical outcomes above-mentioned, which can not been completely explained
by the lipid-lowering effect, so far have not been discovered in previous studies. Thus the
interest of some researchers turned to the other point of view, such as coronary
microcirculation. MI after PCI is a kind of non-ST-segment elevation myocardial infarction
(NSTEMI) related to coronary microcirculation, which can not been detected by coronary
angiography, but can be detected by index of microcirculatory resistance (IMR) examination.
In this study, we will recruit stable angina, unstable angina and acute non-ST-segment
elevation myocardial infarction patients who have been confirmed by coronary angiography. At
the time of enrollment, patients will be randomly assigned to loading dose group
(atorvastatin 80 mg 12 hours before PCI and 40 mg 2 hours before PCI and then 20mg/d after
PCI) or control group (atorvastatin 20 mg 12 hours before PCI and then 20mg/d after PCI).
When PCI is performed, index of microvascular resistance (IMR) will be measured before and
after the procedure. Periprocedural myocardial infarction will be defined by post-PCI
cardiac biomarker. All patients will be followed for adverse cardiac events for 1 month.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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