Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of > or =0.5 mg/dL or > or =25% above baseline within 72 hours after PCI. RESULTS: The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84+/-22.59% vs. 2.43+/-24.49%, p=0.038; -11.44+/-14.00 vs. -9.51+/-13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026). CONCLUSION: High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.

Effect of High Dose Rosuvastatin Loading before Primary Percutaneous Coronary Intervention on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. SUBJECTS AND METHODS: A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. RESULTS: Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0+/-15.9% vs. 22.9+/-16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2+/-19.3 vs. 32.6+/-21.4, p=0.020), and higher MBG (2.49+/-0.76 vs. 2.23+/-0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. CONCLUSION: A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.

Effect of High-Dose Intravenous N-acetylcysteine on the Concentration of Plasma Sulfur-Containing Amino Acids

BACKGROUND: The purpose of this study was to determine the adequate loading and maintenance doses of N-acetylcyseteine (NAC) for patients suffering from acute ROS-induced injury. METHODS: Concentrations of extra cellular NAC, cysteine (Cys), cystine (Cyst2), and methionine (Met) were measured in vitro, at which more than 50% of the intracellular ROS raised by paraquat were suppressed using Swiss 3T3 fibroblasts. An in vivo pharmacokinetic study followed on a healthy subject to determine the proper loading and maintenance doses of reduced NAC following intravenous administration of 25 mg/kg NAC. RESULTS: In vivo, NAC suppressed ROS in a dose dependant manner. 10 mM of NAC suppressed about 50% of ROS, and was comparable to 10 micro M of Cys and Met and 400 micro M of Cys2. In vitro, the elimination of half-life was achieved at 2.88+/-1.14 h for NAC and at 3.68+/-1.84 h for total NAC. The body clearances were 1.23+/-0.77 L h (-1) kg (-1) and 0.56+/-0.27 L h (-1) kg (-1) and the volumes of distribution were 3.07+/-0.10 L kg (-1) and 3.00+/-0.11 L kg (-1), respectively. The loading and maintenance NAC doses used to reach the target concentration of 10 mM, were 5010 mg. kg (-1) and 2250 mg min (-1) kg (-1), respectively. CONCLUSION: NAC provides an antioxidant effect on ROS produced by paraquat in vivo. However, in vitro, our results showed that the intravenous NAC dose could not be estimated from NAC plasma concentration or its metabolites.

Short-Term Effect of High Dose of Vitamin C on Coronary Flow Velocity and Coronary Flow Reserve in Healthy Young Non-Smoker Men

BACKGROUND AND OBJECTIVES: Vitamin C, water-soluble antioxidant, has been reported to restore coronary microcirculatory responsiveness and impaired coronary flow reserve in smokers. However, the effect of high dose of vitamin C on coronary circulation is unclear in nonsmokers. METHODS: We used transthoracic echocardiography to measure the coronary flow reserve, an integrated measure of coronary flow in 20 male healthy nonsmokers (26+/-3 years) before and after administration of the high dose of vitamin C. RESULTS: The coronary peak diastolic velocity was increased by 14.8% after administration of antioxidant vitamin C, whereas the coronary flow reserve did not changed. CONCLUSION: High dose of vitamin C acutely increases the coronary flow velocity without restoration of coronary flow reserve in male healthy nonsmokers.

Changes of Mitral Inflow According to Position in Patients with Dilated Cardiomyopathy

BACKGROUND AND OBJECTIVES: Dilated cardiomyopathy(DCMP) probably is the end result of myocardial damage produced by various causes and shows various clinical manifestations. Some patients with DCMP experience more shortness of breath when change their position especially in left lateral decubitus position. We investigated whether the symptomatic changes according to position in DCMP patients were related to the changes of mitral inflow pattern. MATERIALS AND METHOD: DCMP patients with New York Heart Association functional class III or IV, who felt more shortness of breath when changed their position, were studied. The patients with atrial fibrillation or with moderate and severe valvular heart disease were excluded. Early and late atrial left ventricular filling velocities and time velocity integrals(TVI) and it's ratios of mitral inflow, heart rates, isovolumic relaxation time(IVRT), decelaration time(DT) of early mitral inflow were analysed in each decubitus position. RESULTS: 4 men and 3 women were included and their mean age was 60.3 years. 6 patients had mild mitral regurgitation and 4 patients had mild aortic regurgition. All patients felt more shortness of breath in left lateral decubitus position. Peak velocity and TVI of early mitral inflow were not changed significantly according to position. Peak velocity of late mitral inflow was increased significantly with right lateral decubitus position(Lt; 39.0+/- 14.1cm/sec, Rt; 49. 4+/-23.6cm/sec, p<0.05). TVI of late mitral inflow was increased significantly with right lateral decubitus position(Lt; 2.8+/-1.1cm, Rt; 3.8+/-1.9cm, p<0.05). Ratio of early and late mitral inflow peak velocity was decreased significantly with right lateral decubitus position(Lt; 2.13+ 0.34, Rt: 1.62+/-0.57, p<0.05). Ratio of early and late mitral inflow TVI was decreased significantly with right lateral decubitus position(Lt; 3.13+/-1.49, Rt; 2.13+/-1.32, p<0.01). Heart rate, IVRT, DT were not changed significantly according to position. CONCLUSION: In DCMP patients with symptomatic relief in right lateral position, mitral inflow patterns were changed. And this finding suggests that symptomatic relief may be related to decreased left ventricular filling pressure.