P4630Early intensive lipid-lowering therapy prevents development of no-reflow phenomenon and reduces the incidence of post MI LV remodeling

Abstract

Statin therapy is recommended for all ACS patients regardless of the initial cholesterol level. Previous studies with statins pre-treatment was associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction. However, acute effects of different lipid-lowering regimes on microvascular perfusion recovery and left ventricular remodeling in STEMI patients have been insufficiently studied. The study involved 135 STEMI patients admitted an average of 4.5 hours after symptoms onset and treated with primary PCI. Lipid-lowering treatment was prescribed immediately after hospital admittance. Patients were randomly assigned to one of four groups treated by average (group I and group II) or high (group III and group IV) intensity lipid-lowering therapy. Group I (26 patients) was assigned to atorvastatin 10 mg /ezetimibe 10 mg combination, group II (24 patients) - to atorvastatin 40 mg, group III (42 patients) - to atorvastatin 40 mg/ ezetimibe 10 mg combination, and group IV (43 patients) - to atorvastatin 80 mg. Myocardial Blush Grade (MBG) was used for angiographic assessment of myocardial reperfusion. Echocardiography was performed to all the patients during the first 24 hours after symptoms onset and 90 days after MI development. LV dilatation was defined as at least 25% increase of end-diastolic volume. Intensive lipid-lowering therapy helped to preserve the microvascular integrity after AMI leading to better functional recovery. MBG 3 was significantly often detected in pts from groups III and IV (p<0.001). Whereas patients in groups I and II significantly often had no-reflow phenomenon (p<0.05) and showed of post-MI LV dilatation after 3 month of treatment in 50% of cases. High intensity lipid-lowering therapy (figure 2) reduced the risk of LV remodeling by 30% (p<0.05). Conclusion: The use of high-intensity lipid-lowering therapy early after STEMI can prevent no-reflow phenomenon during primary PCI and reduce the incidence of post-MI LV dilatation. (Figure Presented).