Comparison of Usefulness of Simvastatin 20 mg Versus 80 mg in Preventing Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

• Published in: The American journal of cardiology Vol. 104; no. 4; pp. 519 - 524
• Main Authors: Xinwei, Jia, MD, Xianghua, Fu, MD, PhD, FACC, Jing, Zhang, MD, Xinshun, Gu, MD, Ling, Xue, MD, Weize, Fan, MD, Guozhen, Hao, MD, Yunfa, Jiang, MD, Weili, Wu, MD, Shiqiang, Li, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.08.2009; Elsevier; Elsevier Limited
• Subjects: Acute Coronary Syndrome - therapy; Acute coronary syndromes; Acute Kidney Injury - chemically induced; Acute Kidney Injury - prevention & control; Aged; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular; Cell adhesion & migration; Clinical outcomes; Comparative studies; Contrast Media - adverse effects; Coronary heart disease; Creatinine - blood; Diseases of the cardiovascular system; Dose-Response Relationship, Drug; Drug therapy; Female; Heart; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Intercellular Adhesion Molecule-1 - blood; Kidney diseases; Kidney Function Tests; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; P-Selectin - blood; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Simvastatin - administration & dosage; Statins; Kidney disease; Human; Atherectomy; Urinary system disease; Angioplasty; Simvastatin; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Contrast; Stent; Percutaneous route; Prevention; Nephropathy; Circulatory system; Cardiology; Acute coronary syndrome; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.04.014

Contrast-induced nephropathy limits the outcomes of percutaneous coronary intervention (PCI). The present study compared the protective effects of different statin doses on renal function. A total of 228 patients with acute coronary syndrome undergoing selective PCI were randomly divided into simvastatin 20-mg group (S20, n = 115) and simvastatin 80-mg group (S80, n = 113). Serum creatinine was measured at admission, the day of PCI, and 24 and 48 hours after PCI. The creatinine clearance was calculated using the Cochcroft-Gault formula. High-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 were also measured before and after the procedure. Contrast-induced nephropathy was defined as a postprocedure increase in serum creatinine of ≥0.5 mg/dl or >25% from baseline. The serum creatinine significantly increased after PCI, with the peak value occurring at 24 hours, and then began to decrease. At 48 hours, the serum creatinine had decreased to the baseline level in the S80 group, but it had failed to do so in the S20 group. At 24 and 48 hours after PCI, the serum creatinine was lower in the S80 group than in the S20 group (p <0.05 and p <0.001, respectively). The creatinine clearance significantly decreased after PCI, with the lowest value occurring at 24 hours, and then it began to increase. In the S80 group, the creatinine clearance recovered to baseline level at 48 hours, but it failed to do so in the S20 group. The creatinine clearance was greater at 24 and 48 hours in the S80 group than that in the S20 group. Although the procedure caused a significant increase in high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels, the value was lower in the S80 group than in the S20 group (p <0.001). In conclusion, pretreatment with simvastatin 80 mg before PCI could further decrease the occurrence of contrast-induced nephropathy compared with simvastatin 20 mg. This benefit was associated with the lowering of high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels.