COMPARATIVE STUDY OF THE IMPACT OF LOADING DOSES OF ATORVASTATIN AND ROSUVASTATIN ON THE IMMEDIATE POST-PCI TIMI FLOW IN PATIENTS RECEIVING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Abstract

Objective

This study aims to assess and contrast the immediate effects of administering loading doses of atorvastatin and rosuvastatin on Thrombolysis in Myocardial Infarction (TIMI) flow following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.

Methodology

From April 2023 to April 2024, a prospective randomized controlled trial was conducted at XYZ Hospital involving 110 eligible patients to compare the effects of administering a loading dose of rosuvastatin (40 mg) versus atorvastatin (80 mg) on Thrombolysis In Myocardial Infarction (TIMI) flow immediately following percutaneous coronary intervention (PCI), left ventricular ejection fraction (LVEF) at discharge, and Major Adverse Cardiovascular Events (MACE) over a one-month period in patients with ST-elevation myocardial infarction (STEMI). Eligible participants were adults aged 18 and older with confirmed STEMI requiring primary PCI, excluding those with contraindications to statin therapy, severe hepatic or renal impairments, pregnancy, lactation, recent clinical trial participation, or ineligibility for PCI. Baseline demographic and clinical data were collected, including age, gender, BMI, smoking status, and medical history. TIMI flow grades post-PCI were assessed, with TIMI-3 indicating complete perfusion. Secondary endpoints included peak troponin-I levels 24 hours post-PCI and LVEF at discharge. MACE were monitored during a one-month follow-up. Statistical analyses were performed using multivariable regression to adjust for confounders, and results were analyzed with IBM SPSS Statistics version 25. The study adhered to ethical standards, with informed consent obtained and approval from the institute's ethical review board.

Results

Both groups, each comprising 55 patients, were comparable in terms of mean age, gender distribution, BMI, and cardiovascular risk factors. No significant differences were found in the extent of coronary artery disease, with similar rates of single, two, and three-vessel disease. Post-PCI TIMI-3 flow, indicating complete perfusion, was achieved in 81.8% of the rosuvastatin group and 83.6% of the atorvastatin group. Secondary endpoints, including peak highly-sensitive troponin-I levels and left ventricular ejection fraction (LVEF) at discharge, showed no significant differences between the groups. Major adverse cardiovascular events (MACE) within one month were also comparable, occurring in 5.5% of the rosuvastatin group and 9.1% of the atorvastatin group. The study concluded that both statins provided similar outcomes in terms of coronary blood flow restoration and cardiac function post-PCI.

Conclusion

Our study shows that pre-loading patients with both rosuvastatin and atorvastatin are effective in restoring coronary blood flow after primary PCI in STEMI patients. The similar TIMI-3 flow grades and peak troponin levels indicate both statins are equally capable of reducing acute myocardial damage. Rosuvastatin also showed a trend towards fewer major adverse cardiovascular events and improved LV ejection fraction. The management of acute coronary syndrome with high-intensity statins is supported by these findings.