Early intensive treatment with statins improves regional longitudinal systolic strain in patients with acute myocardial infarction

Abstract

Purpose: Statins have been shown to have beneficial pleiotropic effects besides being lipid lowering. We hypothesized that early and intensive statin treatment was associated with improved left ventricular (LV) function in patients with acute myocardial infarction (AMI). Methods: In a prospective randomized blinded endpoint trial patients with ST segment elevation or non ST segment elevation AMI were randomized to either intensive statin-therapy (loading dose rosuvastatin 80 mg immediately after randomization followed by 40 mg daily) or usual statin therapy (simvastatin 40 mg daily). Echocardiography was performed at randomization and after 30 days. Regional LV function was assessed using 2D Speckle Tracking with assessment of regional longitudinal systolic strain (RLS). Primary outcome for this study was RLS in the myocardial region of the infarct related coronary artery. The Culprit vessel and location of the infarction was identified from the coronary angiography All echocardiograms were analyzed blinded for allocated statin group. In addition to univariate analysis primary endpoint was adjusted for possible confounders in a multiple regression model. Results: Overall 140 patients were included. The intensive treatment group received first dose of statin 14 [range 11; 16] hours after admission and the usual care group received first dose after 27 [23; 32] hours, p<0.001. Thirty-five patients were excluded from the study because of poor image quality or uncertain culprit vessel. Of the remaining 105 patients 54 were randomized to receive intensive statin therapy and 51 received the usual care. In the intensive statin group RLS in the culprit area improved from -10.71 (95% CI: -12.11;-9.31) at baseline to-15.54 (95% CI: -16.88;-14.17) after 30 days, p<0.001. In the usual care group RLS improved from -11.87 (95% CI: -13.4;-10.34) at baseline to -14.47 (95% CI -15.52;-13.43) after 30 days, p<0.001. The improvement in RLS was significantly higher in the intensive care group (-4.82 (95% CI: -6.17;-3.47)) compared with the usual care group (mean -2.6 (95% CI; -3.74;-1.46)), p=0, 014. The difference remained significant after adjustment for potential confounders, P=0.04 Conclusions: Intensive and early statin treatment with rosuvastatin improves regional longitudinal systolic function in the infarct area compared to simvastatin in patients with AMI.