The purpose of this study is to determine whether a loading dose of atorvastatin before percutaneous intervention procedures in acute coronary syndromes is effective to reduce major cardiovascular events(MACE).
Background: Strategies to reduce complications in acute coronary syndrome treatment have been largely studied. Due to its pleiotropic effects statins are considered an important tool on atherosclerotic plaque stability. Although, the usage of statins before percutaneous coronary intervention in acute coronary syndrome patients, has not yet been demonstrated. Objectives: Evaluate if a loading dose of atorvastatin (80mg) before percutaneous coronary intervention in acute coronary syndrome patients, followed by a reload dose 24 hours, is able to reduce major cardiovascular events (MACE); including combined outcomes such as all-cause mortality, nonfatal acute myocardial infarction, stroke or revascularization with either percutaneous coronary intervention or coronary-artery bypass grafting after 30 days. Methods: Multicentric randomised controlled clinical trial, with allocation concealment and intention to treat analysis. Competitive recruitment will involve 4,192 patients. Acute coronary syndrome patients intending to undergo percutaneous coronary intervention with or without stent placement will be randomized 1:1 to receive either atorvastatin 80mg or placebo before the coronary procedure and also a reload dosage after 24 hours from angioplasty. All patients will collect blood sample to determine CKMB levels pre and post procedure (6 to 12h and 18 to 24 hours). After 30 days, an in person interview will be performed and blood sample will be collected in order to dosage AST, ALT, CPK, and cholesterol levels. Telephonic interview will be done at 6 and 12 months to access occurrence of cardiovascular events.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
4,191
Atorvastatin loading dose of 80mg before PCI, reloading dose of 80mg 24 hours after PCI, and atorvastatin 40mg for 30 days
Matching placebo before PCI and 24 hours after PCI. Atorvastatin 40mg for 30 days
Hospital do Coracao
São Paulo, São Paulo, Brazil
Major Cardiovascular Events (MACE)
All-cause mortality, nonfatal acute myocardial infarction, stroke or revascularization with either percutaneous coronary intervention or coronary artery bypass grafting
Time frame: 30 days
Major Cardiovascular Events (MACE)
Time frame: 6 months and 12 months
All-cause mortality
Time frame: 30 days, 6 months and 12 months
Non-fatal Myocardial Infarction
Time frame: 30 days, 6 months and 12 months
Non-fatal Stroke
Time frame: 30 days, 6 months and 12 months
Revascularization
Time frame: 30 days, 6 months and 12 months
Cardiovascular death
Time frame: 30 days, 6 months and 12 months
Stent Thrombosis
Time frame: 30 days, 6 months and 12 months
Target vessel revascularization
Time frame: 30 days, 6 months and 12 months
Rhabdomyolysis
Time frame: 7 days or at hospital discharge
Bleeding episode
Time frame: 7 days or hospital discharge
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