Liều nạp statin trong hội chứng vành cấp có thực sự đem lại lợi ích ngắn hạn và dài hạn

High dose statin loading in ACS– short & long term outcomes benefit Dinh Duc Huy, MD, FSCAI Tam Duc Heart Hospital 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation ACS Cholesterol Management Class I High-intensity statin therapy should be initiated or continued in all patients with NSTE-ACS and no contraindications to its use (Level of Evidence: A) Class IIa It is reasonable to obtain a fasting lipid profile in patients with NSTE-ACS, preferably within 24 hours of presentation (Level of Evidence: C) 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Lipid Management: Recommendations CLASS I High-intensity statin therapy should be initiated or continued in all patients with STEMI and no contraindications to its use (Level of Evidence: B) CLASS IIa It is reasonable to obtain a fasting lipid profile in patients with STEMI, preferably within 24 hours of presentation (Level of Evidence: C) ARMYDA-ACS trial: Study design 580 pts excluded for: - 451 statin therapy - 41 emergency angiography - 43 LVEF 70% (81% vs 67, p= 0.005) Statin loading prior to PPCI remained independent predictor of early STR (OR 2.97, CI 1.62-5.45, p=0.00005) in multivariable analysis Diego Medvedofsky J Am Coll Cardiol 2013;61(10_S): doi:10.1016/S0735 1097(13)60066-2 Young-Guk Ko, Am J Cardiol 2014;114:29-35 ROSEMARY study main findings Serial MRI data were available for 121 patients The relative infarct volumes in the acute and chronic phases were not different between the groups No differences between groups were observed for peri-procedural micro-vascular circulation evaluated by TIMI flow grade, myocardial blush grade, ST-segment resolution, micro-vascular obstruction on cardiac MRI, or clinical outcomes Early high-dose rosuvastatin therapy in patients with STEMI undergoing PPCI did not improve peri-procedural myocardial perfusion or reduce infarct volume measured by MRI compared with the conventional low-dose rosuvastatin regimen Young-Guk Ko, Am J Cardiol 2014;114:29-35 Evaluate the incidence of peri-procedure MI and MACE including spontaneous MI, death, and TVR of statin naïve patients presenting with stable angina or NSTE-ACS and treated with statins prior to PCI Alexandre M Benjo, Catheterization and Cardiovascular Interventions 85:53–60 (2015) High dose statin therapy given prior to PCI in patients with NSTE-ACS is associated with a reduction in pMI and short-term clinical events Alexandre M Benjo, Catheterization and Cardiovascular Interventions 85:53–60 (2015) Main findings from the meta-analysis (1,210 articles, 14 RCTS, 3,146 patients) • 1,591 patients were given loading dose of statin before PCI • 1,555 patients were given statin therapy initiated only after the PCI • Statin loading prior to PCI was associated with a 56% RR in pMI (OR: 0.44, P