Percutaneous coronary interventions and statin therapy

Lipid lowering therapy with statins reduces the risk of cardiovascular events in patients with coronary artery disease. Recent in vitro and in vivo studies demonstrated LDL-independent action of this class of drugs, which appears in modulating endothelial function, inflammation and thrombosis. Periprocedural myocardial infarction and contrast induced nephropathy after percutaneous coronary intervention (PCI), associated with worse outcome on short and long term follow-up, are both complications related to inflammatory pathogenetic mechanisms. Randomized studies showed a beneficial effect of short-term statin pretreatment in reducing peri-procedural cardiac markers release in patients undergoing PCI. In fact, statin therapy before elective PCI reduced periprocedural myocardial infarction in patients with stable angina. Furthermore, an acute loading with high-dose atorvastatin prevented myocardial damage in patients with acute coronary syndromes undergoing early PCI (<48 hours). In patients already on chronic statin therapy, a reload with high dose statin was associated with a significant improvement on 30-day cardiac outcome. Finally, statin therapy at the time of PCI significantly decreased the incidence of contrast-induced nephropathy. All these evidences support an "upstream administration" of short-term, high-dose statins in all patients undergoing PCI, in order to achieve pleiotropic, LDL-independent effects of these drugs.