Low dose statins in secondary prevention in patients after percutaneous coronary interventions

Introduction: In addition to invasive coronary revascularization procedures (PCI) in the treatment of ischemic heart disease indication of a systemic therapy could prevent recurrent events. The initiation of statin treatment as early as possible and the maintenance of a good adherence to statin therapy would lead to a more favorable clinical course in post-PCI period. Aim: The purpose of this study was to evaluate the effect of low dose statins on the incidence of cardiovascular events and of cardiovascular composite endpoint, which included myocardial infarction, stroke, recurrent angina and repeat revascularization, in patients undergoing percutaneous coronary interventions with stent implantation. Methods: We conducted a retrospective study that included 95 patients after coronary angioplasty with stenting. According to statin therapy these patients were divided into two groups: 1st group – without statin treatment in post-PCI period (32 patients, mean age of 59 ± 1.53 years) and 2nd group – patients with statin treatment in post-PCI period (63 patients, mean age of 58 ± 1.09 years). 67.7% of patients in 2nd group received simvastatin (10 – 20 mg/d, the mean dose – 16.5 mg/d), 25.4% – atorvastatin (10 – 20 mg/d, the mean dose – 14.9 mg/d) and 6.9% – other statins (pravastatin, lovastatin). The high percentage of patients that were not receiving statins is explained by low medication compliance. The incidence of cardiovascular events was assessed at 6.51 ± 0.15 months post-PCI. Results: 12.5% patients in 1st group experienced at 6 months post-PCI a major adverse cardiovascular event (3 patients – stroke and 1 patient – acute myocardial infarction) vs. 0% patients in 2nd group (p < 0.05). The incidence of cardiovascular composite endpoint also was higher in 1st group vs. 2nd group – 62.5% (20) vs. 38.1% (24), p < 0.05. Administration of low dose statins did not influence at 6 months post-PCI the need for repeat coronary angiography (18.6% (6) patients in 1st group vs. 15.9% (10) in 2nd group, p > 0.05), repeat revascularization (15.6% (5) vs. 15.6% (10), p > 0.05) and target lesion revascularization (12.5% (4) vs. 7.9% (5), p > 0.05). Clinical instent restenosis was determined in 12.5% (4) patients in the no-statin group and 7.9% (5) patients in the statin group (p > 0.05). Conclusions: Patients undergoing percutaneous coronary intervention with stent implantation in the absence of statin therapy have a higher risk of developing a cardiovascular event than patients on statin therapy. This study suggests that low dose statins have a favorable effect on clinical outcome in patients after PCI. Therefore statin therapy should be administered to all patients undergoing coronary interventional procedures.

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