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Erschienen in: Basic Research in Cardiology 6/2011

01.11.2011 | Original Contribution

Failure to recapture cardioprotection with high-dose atorvastatin in coronary artery bypass surgery: a randomised controlled trial

verfasst von: Andrew J. Ludman, Derek J. Hausenloy, Girish Babu, Jonathon Hasleton, Vinod Venugopal, Edney Boston-Griffiths, John Yap, David Lawrence, Martin Hayward, Shyam Kolvekar, Giulio Bognolo, Paul Rees, Derek M. Yellon

Erschienen in: Basic Research in Cardiology | Ausgabe 6/2011

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Abstract

The acute administration of atorvastatin has been reported to reduce myocardial infarct size in animal studies. However, this cardioprotective effect is lost with the chronic administration of atorvastatin, although it can be recaptured by administering an acute high-dose of atorvastatin. We hypothesised that pre-treatment with high-dose atorvastatin, on a background of chronic standard ‘statin’ therapy, would reduce myocardial injury in patients undergoing elective coronary artery bypass graft (CABG) surgery. One hundred and one consenting patients undergoing elective CABG surgery at a single tertiary cardiac centre were recruited into two randomised controlled, single-blinded clinical studies. Study 1: 45 patients were randomised to receive either 160 mg of atorvastatin 2 h preoperatively and 24 h following surgery or their standard statin therapy. Study 2: 56 patients were randomised to receive either 160 mg of atorvastatin 12 h preoperatively and 24 h following surgery or their standard statin therapy. Blood samples for troponin T and creatine kinase were taken prior to surgery and then at 6, 12, 24, 48 and 72 h post-surgery. Cardiac enzyme levels at each time point and the total area-under curve (AUC) were calculated. The group characteristics and surgical methods were well matched. High-dose atorvastatin was not associated with any significant side effects. There was no significant difference in serum troponin T or creatine kinase in either study at each time point or over 72 h. Study 1: AUC, troponin T: atorvastatin 29.6 ± 34.8 μg/L versus control 25.0 ± 22.0 μg/L:P > 0.05. Creatine kinase: atorvastatin 33,544 ± 20,063 IU/L versus control 30,620 ± 10,776 IU/L:P > 0.05. Study 2: AUC, troponin T: atorvastatin 21.8 ± 14.3 μg/L versus control 20.9 ± 8.7 μg/L:P > 0.05. Creatine kinase: atorvastatin 36,262 ± 28,821 IU/L versus control 33,448 ± 14,984:P > 0.05. There were no differences in postoperative outcomes. We report that the administration of high-dose atorvastatin to low risk patients undergoing elective CABG surgery, who are already on standard dose ‘statin’ therapy is safe, but does not further reduce perioperative myocardial injury.
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Metadaten
Titel
Failure to recapture cardioprotection with high-dose atorvastatin in coronary artery bypass surgery: a randomised controlled trial
verfasst von
Andrew J. Ludman
Derek J. Hausenloy
Girish Babu
Jonathon Hasleton
Vinod Venugopal
Edney Boston-Griffiths
John Yap
David Lawrence
Martin Hayward
Shyam Kolvekar
Giulio Bognolo
Paul Rees
Derek M. Yellon
Publikationsdatum
01.11.2011
Verlag
Springer-Verlag
Erschienen in
Basic Research in Cardiology / Ausgabe 6/2011
Print ISSN: 0300-8428
Elektronische ISSN: 1435-1803
DOI
https://doi.org/10.1007/s00395-011-0209-5

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