Short-term High-Dose Atorvastatin Pretreatment To Prevent Contrast-Induced Nephropathy In Patients With Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention

ObjectiveTo evaluate whether short-term high-dose atorvastatin administered before emergency percutaneous coronary intervention(PCI) could reduce the incidence of contrast-induced nephropathy(CIN) in patients with acute myocardial infarction.Methods120consecutive patients with acute ST-segment elevation myocardial infarction(STEMI) were treated with emergency PCI from June2010to December2011. All eligible patients were randomized to receive20mg of atorvastatin(control group, n=60) or60mg of atorvastatin(study group, n=60) before PCI and for7days after contrast exposure. All patients had long-term atorvastatin treatment thereafter(20mg/d). A nonionic,low-osmolar,iodinated contrast agent(iopamidol) was used during the intervention. All patients were received intravenous standard hydration with isotonic saline. The change of serum creatinine(SCr),serum cystatin C(Cys C),estimated glomerular filtration rate(eGFR) before andl,2,3,5and7days after PCI. CIN was defined as an increase in the SCr values of≥25%or≥0.5mg/dl from the baseline within3days after PCI. The primary end point was incidence of CIN. Additional end point was30-day incidence of major adverse cardiovascular events. The correlation between Cys C and Scr、eGFR were also be studied.Results1. There were no significant differences in the levels of SCr,Cys C and eGFR between the two groups at different time(P>0.05). The level of Scr in the two groups significantly increased2days after PCI(P<0.05); Scr reached its peak level3days after PCI,and then began to decrease,Scr decreased to the baseline level7days after PCI. In the study group,the level of Cys C or eGFR significantly increased or decreased1day after PCI(P<0.05),with the highest or lowest value occurring at2days,and then return to the baseline level5days after PCI. But in the control group, Cys C or eGFR return to the baseline level7days after PCI.2. There were6patients developed CIN,4cases in the control group and2cases in the control group. There was no significant difference in the incidence of CIN between the two groups(6.7%vs.3.3%, P=0.675). In a subgroup analysis show that there was no CIN occurred in patients with normal renal function. In the patients with renal insufficiency,23.5%of those in the study group developed CIN versus10.0%of those in the control group, but there was no significant differences between the two groups(P=0.383).3. Pearson correlation analysis demonstrated that preprocedural Cys C value was positively correlated with Scr(r=0.733,P<0.01), and negative correlated with eGFR(r=-0.771,P<0.01).4. At follow-up of30days, the incidence of a composite end point including cardiac death, non-fetal myocardial infarction or recurrent infarction,targeted vessels revascularization,angina pectoris,worsening heart failure in the study group was significantly lower than those in the control group(8.3%vs.23.3%,P<0.05).Conclusion: 1. A short-term administration of high doses of atorvastatin before emergency PCI, in addition to standard intravenous hydration, does not decrease CIN occurrence in patients with acute STEMI.2.The Cys C can detect acute kidney injury earlier than Scr, it has a well correlation with eGFR.