Lucie Martinkovičová

Effect of two-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following elective percutaneous coronary intervention: a single-center, prospective, and randomized study.

Both randomized and observational studies have suggested that pretreatment with statins may reduce the incidence of periprocedural myocardial infarction (PMI) in patients with stable angina during elective percutaneous coronary intervention (PCI). The purpose of this randomized study (Clinical Trial Registration No. NCT00469326) was to investigate the effect of 2-day atorvastatin therapy on the incidence of PMI in patients with stable angina pectoris undergoing elective PCI. A total of 200 patients with stable angina pectoris who were not taking statins and who had been referred for PCI were enrolled and randomized (ratio 1:1) to a 2-day pretreatment regimen with atorvastatin 80 mg/day and subsequent PCI or immediate PCI. The serum concentration of creatine kinase-MB mass and troponin I were measured before and 16 to 24 hours after PCI. The incidence of PMI was assessed using established criteria. Of the patients, 10% in the atorvastatin group and 12% in the control group had a postprocedural creatine kinase-MB mass elevation > or =3 times the upper limit of normal (p = 0.65). The incidence of PMI as determined by the postinterventional release of troponin I > or =3 times the upper limit of normal was 17% in the atorvastatin group and 16% in the control group (p = 0.85). The median creatine kinase-MB mass peak after PCI was 1.46 ng/ml (interquartile range 0.83 to 2.52) in the atorvastatin group and 1.40 ng/ml (interquartile range 0.90 to 2.54) in the control group (p = 0.70). The median peak troponin I level after PCI was 0.100 ng/ml (0.096 to 0.385) in the atorvastatin group and 0.100 ng/ml (0.60 to 0.262) in the control group (p = 0.54). On multivariate analysis, the only independent predictor of PMI was patient age (odds ratio 1.09, 95% confidence interval 1.025 to 1.159, p = 0.006). In conclusion, in the present study 2-day pre-PCI therapy with atorvastatin did not reduce the occurrence of PMI in patients with stable angina pectoris undergoing elective PCI.

Feasibility, safety, and early outcomes of direct carotid artery stent implantation with use of the FilterWire EZ™ Embolic Protection System†

To report on early outcomes of prospective single‐center registry, which evaluated feasibility, safety, and effectiveness of direct carotid stenting using FilterWire EZ™ Embolic Protection System in high‐risk patients.

Effect of Two-Day Atorvastatin Pretreatment on Long-Term Outcome of Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Intervention

Several randomized studies and meta-analyses have suggested that pretreatment with statins may decrease periprocedural myocardial infarction (MI) in patients undergoing percutaneous coronary intervention (PCI). The purpose of this randomized study was to investigate the effect of a 2-day atorvastatin therapy before PCI on long-term clinical outcome. Two hundred statin-naive patients with stable angina pectoris referred for PCI were enrolled and randomized (ratio 1:1) to 2-day pretreatment with atorvastatin 80 mg/day and subsequent PCI (atorvastatin group), or immediate PCI (control group). The registry group comprised 182 consecutive patients on long-term statin therapy referred for immediate PCI during the same period as randomized patients. We compared the first occurrence of MI or death during long-term follow-up. There were no significant differences in most clinical characteristics and early results among the 3 groups. Median follow-up was 45 months (1 to 59). Incidences of death/MI were 11.4%, 12.9%, and 13.8% in the atorvastatin, control, and registry groups, respectively. In the same groups, age-adjusted estimated 4-year freedom from death/MI was 0.78 versus 0.75 versus 0.80, respectively (p=0.882, log-rank test). In multivariate analysis, only age of patients (odds ratio 1.04, 95% confidence interval 1.02 to 1.07, p<0.001) was identified as a significant predictor of death or MI during follow-up. In conclusion, these results suggest that 2-day therapy with high-dose atorvastatin before PCI did not influence occurrence of periprocedural MI or long-term clinical outcomes.

Effect of seven-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following percutaneous coronary intervention in patients receiving long-term statin therapy. A randomized study☆

BACKGROUND The aim of this randomized study was to investigate the effect of seven-day high-dose atorvastatin therapy on the incidence of peri-procedural myocardial infarction (PMI) in patients receiving long-term statin therapy. METHODS The patients with stable angina receiving statin therapy and referred for percutaneous coronary intervention (PCI) were randomized (ratio 1:1) to a 7-day pre-treatment with atorvastatin of 80 mg daily and subsequent PCI (Atorvastatin group), or immediate PCI (Control group). The incidence of PMI was based on serum concentration of creatine kinase myocardial band (CK-MB) mass and troponin I (TnI), which were measured prior to and between 16 and 24h post PCI. The values were considered as positive if they were elevated ≥ 3 times the upper limit normal. RESULTS We randomized 202 patients (male 67%, 65.5 ± 9.2 years; 100 vs. 102 pts.). There were no significant differences in the baseline characteristics among the randomized groups. The incidence of PMI, based on post-interventional release of TnI and/or CK-MB mass was 15% in the Atorvastatin group vs. 14% in the Control group (p=0.80). One patient (3%) in Atorvastatin group suffered from MI between randomization and PCI. CONCLUSIONS These results suggest that 7-day pre-PCI therapy with high-dose atorvastatin did not reduce the occurrence of PMI in patients receiving chronic statin therapy.

Predictors of coronary intervention-related myocardial infarction in stable angina patients pre-treated with statins.

Introduction Peri-procedural myocardial infarction (PMI) is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). This study was designed to determine the predictors of PMI in patients pre-treated with statins. Material and methods A total of 418 stable angina pectoris patients taking statins and aspirin were included. All the patients underwent PCI. Serum concentrations of creatine kinase (CK-MB mass) and troponin I (TnI) were measured prior to and then within 16 to 24 hours after PCI. The incidence of PMI was assessed using the established criteria (≥ 3 times upper limit of normal). Results Four hundred and eighteen stable patients (63 ±10 years, 68% males) were treated by PCI. The technical success rate of PCI was 99%. The incidence of PMI based on CK-MB mass or TnI release was 12% (PMI group). There were no significant differences in baseline clinical and procedural characteristics between PMI and non-PMI groups except for the balloon inflation time (40 ±44 s vs. 26 ±27 s; p = 0.02) and the proportion of treated type C lesions (42% vs. 28%; p = 0.03). In multivariate analysis, the independent predictors of PMI were balloon inflation time (OR = 1.01; 95% CI 1.001-1.020; p = 0.02) and pre-procedural level of C-reactive protein (OR = 1.38; 95% CI 1.059-1.808; p = 0.02). Conclusions These results suggest that C-reactive protein and balloon ischaemic time are independent predictors of PMI in stable angina patients pre-treated with statins.

Comparison of Carotid Artery Stenting in Patients With Single Versus Bilateral Carotid Artery Disease and Factors Affecting Midterm Outcome

BACKGROUND Carotid artery stenting (CAS) is the method of choice for carotid artery revascularization of patients at high risk for carotid endarterectomy. In this study, we compared the midterm results of CAS in patients with unilateral versus bilateral carotid artery disease. METHODS AND RESULTS This is a retrospective analysis of 1-year outcome of 273 consecutive patients in whom 342 CAS procedures were performed. The incidence of periprocedural transient ischemic attacks (TIAs) differed significantly (8% vs. 1%; p = 0.01) among patients with and without bilateral internal carotid disease, and a tendency to a lower occurrence of early adverse events (death, stroke, periprocedural TIA, periprocedural myocardial infarction) was subsequently shown (11% vs. 5%; p = 0.12). At 1-year follow-up, there was a high incidence of adverse events (death, stroke, periprocedural TIA, periprocedural myocardial infarction, restenosis) in patients with bilateral carotid artery disease (40% vs. 14%; p < 0.01), which was mainly driven by a higher incidence of death, periprocedural TIA, and restenosis (p ≤ 0.02 for all). According to multivariate analysis, the independent predictors of midterm adverse events were left ventricular dysfunction, male gender, bilateral carotid artery disease, renal insufficiency, cerebral symptoms within the last 6 months before the intervention, and low-density lipoprotein cholesterol level. CONCLUSIONS At midterm follow-up, patients with bilateral carotid artery disease treated by CAS have significantly more adverse events than those with unilateral disease.

Comparison of mid-term outcomes of carotid artery stenting for moderate versus critical stenosis

Introduction Little is known about the prognosis of moderate versus critical carotid stenosis treated by carotid artery stenting (CAS). Material and methods This was a retrospective analysis of a single-centre registry including 271 consecutive patients (69 ±9 years, 87% at high risk for surgery), in whom 308 procedures were performed. The study included both symptomatic (≥ 50% carotid artery stenosis) and asymptomatic (≥ 70% carotid artery stenosis) patients. The primary endpoint was the rate of adverse events during follow-up (range 1-48 months), defined as all-cause death or stroke. Results We treated 115 critical and 193 moderate stenoses and implanted 318 stents (56% with closed cell design). Embolic protection systems were used in 296 cases (96%). The technical success rate was 98.2% in the critical stenoses group and 99% in the moderate group (NS). During follow-up, the incidence of the primary endpoint was 12.9% (13 pts) in the critical stenoses group and 14.7% (25 pts) in the moderate stenoses group (estimated 3-year freedom from death/stroke was 0.844 vs. 0.812; log-rank test p = 0.983). Left ventricular ejection fraction < 40%, significant contralateral carotid artery occlusion or stenosis and renal insufficiency were identified as significant predictors of the primary endpoint (p < 0.03). Conclusions Carotid artery stenting with embolic protection systems in patients at high risk for carotid endarterectomy is safe. Patients with initially moderate and critical stenoses have an identical mid-term prognosis with regard to death and stroke.