ARMYDA-ACS (Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndrome trial)

18 Aug, 10

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ARMYDA-ACS

Background

Atorvastatin pretreatment improves outcomes in ACS patients undergoing early PCI: Results of ARMYDA-ACS trial.
The efficacy of atorvastatin pretreatment in acute coronary syndrome (ACS) patients undergoing early PCI has not been evaluated.

Aim

To evaluate the effects of pretreatment with atorvastatin in ACS patients undergoing early PCI (<48 hours)

Patients

ACS patients undergoing early PCI (<48 hours) [N= 171]

Study Groups

Atorvastatin (80 mg 12 hours before coronary angiography + 40 mg 2 hours before angiography) + standard therapy (clopidogrel, aspirin, GP IIb-IIIa inhibitors and heparin) [N=86] vs. placebo + standard therapy (clopidogrel, aspirin, GP IIb-IIIa inhibitors and heparin) [N=85]
After angioplasty, patients in both the groups received atorvastatin 40 mg/day

Follow-up Period

30 days

Efficacy Outcomes

Primary endpoint was the occurrence of major adverse cardiac events (composite end-point of death, MI and target vessel revascularization)
Secondary end-points were any postprocedural increase of markers of myocardial injury (creatine kinase-MB, troponin-I) above upper limits of normal and posprocedural variations from baseline C-reactive protein (CRP) levels in both groups

Results

The incidence of major adverse cardiac events was significantly reduced with atorvastatin pretreatment, largely driven by a significant reduction in MI (Table 1).

Table 1. Comparison of efficacy outcomes

There was a significantly better event-free survival at 30 days in atorvastatin pre-treatment group (Figure 1).

Figure 1. Survival curves at 30 days

Multivariate analysis showed that atorvastatin pretreatment significantly lowered the risk of major adverse cardiac events by 88%
After PCI, the number of patients with elevated levels of creatine kinase- MB and troponin-I was significantly lower in the atorvastatin pre-treatment group (Figure 2)
Average increase in CRP was significantly lower with atorvastatin pre-treatment (Figure 2)

Figure 2. Effect on inflammatory markers

Conclusion

Short-term pretreatment with atorvastatin improves clinical outcomes in ACS patients undergoing early PCI.

J Am Coll Cardiol 2007; 49: 1272-8

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