TIMI Study Group， Cardiovascular Division， Department of Medicine， Beth Israel Deaconess Medical Center， Boston， Massachusetts 02115， USA. mgibson@perfuse.org
Abstract
OBJECTIVES: The goal of this analysis was to determine whether intensive statin therapy， compared with moderate-dose statin therapy， leads to a reduction in major adverse cardiovascular events (MACE) among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
BACKGROUND: When compared with moderate-dose statins， intensive statin therapy reduces MACE among patients with ACS. The role of intensive statin therapy specifically among patients who undergo PCI for ACS is unknown.
METHODS: Outcomes were compared in 2，868 patients who underwent PCI for ACS just prior to enrollment in the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial， which randomized patients to either atorvastatin 80 mg or pravastatin 40 mg daily. The incidence of the primary composite end point of all-cause mortality， myocardial infarction， unstable angina leading to hospitalization， and revascularization after 30 days and stroke was evaluated， as was the incidence of target vessel revascularization (TVR) and non-TVR during follow-up.
RESULTS: Treatment with 80 mg atorvastatin reduced the incidence of the composite end point (21.5% vs. 26.5%， hazard ratio: 0.78， 95% confidence interval: 0.67 to 0.91， p=0.002) and lowered the incidence of both TVR (11.4% vs. 15.4%， p=0.001) and non-TVR (8.0% vs. 10.5%， p=0.017) compared with 40 mg pravastatin. After adjusting for on-treatment serum low-density lipoprotein cholesterol and C-reactive protein concentrations， the odds of TVR with high-dose statin therapy remained significant (odds ratio: 0.74， p=0.015) while the odds of non-TVR did not (odds ratio: 0.92， p=0.55).
CONCLUSIONS: Among patients with ACS who undergo PCI， intensive statin therapy reduces MACE compared with moderate-dose statin therapy. The reduction in the incidence of TVR was independent of low-density lipoprotein cholesterol and C-reactive protein lowering and may therefore be due， at least in part， to a pleiotropic effect of high-dose statin therapy.