Prevention of acute kidney injury in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: comparison of atorvastatin and rosuvastatin in «case – control» study
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Abstract
The aim – to perform retrospective comparison of the effects of rosuvastatin and atorvastatin started during prompt (less than 120 min) terms before coronary angiography, upon rate of the acute kidney injury (AKI) at the 3rd day of acute myocardial infarction, and upon hospital clinical course of the disease.
Materials and methods. The retrospective cohort of 254 patients with ST-elevation myocardial infarction (STEMI) was studied. All patients underwent PCI (angiography alone, or followed by angioplastic/stenting) and had serial serum creatinine data. AKI (determined as rise in serum creatinine ≥ 44 μmol/l or ≥ 25 % rise in creatinine over baseline) was present in 40 cases (15.7 %). Then all cases were brought to the automated case-match-control pairing algorithm. Two matched groups of patients were elected: 23 pts were treated with rosuvastatin (R-group) and 23 pts were treated with atorvastatin (A-group). Cases were matched by clinical criteria, including: age, gender, weight, baseline creatinine level, prescription of some drugs, which could affect serum creatinine levels (ACE inhibitors, intestinal adsorbents, trimetazidine, quercetin, ADP-receptors blockers). Groups were similar in terms of statin dosage (15.2±1.0 mg QD in R-group and 37.8±3.4 mg QD in A-group), diabetes mellitus history, rate of left ventricular heart failure (LVHF) at baseline. Patients with severe congestive heart failure, nephropathy, anemia and systemic hypotension/shock at baseline were excluded.
Results. Mean baseline serum creatinine level was 87.8±3.6 μmol/l in R-group and 88.9±2.8 μmol/l in A-group (Р>0.1). Incremental dynamics of the serum creatinine level was observed in 30.4 % and 56.5 % pts of R-group and A-group, respectively (mean 18.5±2.3 % vs 28.7±4.3 % of increase, respectively, Р<0.05). Rate of AKI incidence was 4.3 % in R-group and 26.1 % in A-group (Р<0.05). The cumulative rate of 2–10 day STEMI-related adverse events (recurrent ischemia/MI, acute LV aneurysm, late ventricular arrhythmias) and hemorrhagic events was 21.7 % in R-group and 56.5 % in A-group (Р<0.05).
Conclusion. Although recent data shows the preventive effect of contemporary statin treatment on AKI development in STEMI patients after coronary angiography, our data suggest that different statins may not have the same impact in this regard. Data about superiority of rosuvastatin over atorvastatin in prevention of AKI and related worsening of STEMI clinical course requires further investigation including larger number of patients in a prospective trial.
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Наказ Міністерства охорони здоров’я №455 від 02.07.2014 року «Уніфікований клінічний протокол екстреної, первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги та медичної реабілітації хворих на гострий коронарний синдром з елевацією сегмента ST» // Серцево-судинні захворювання. Классифікація, стандарти діагностики та лікування» / За ред. В.М. Коваленка, М.І. Лутая, Ю.М. Сіренка, О.С. Сичова.– К.: Моріон, 2016.– С. 34–40.
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