Reducing Cardiovascular Events After PCI

Research has shown that when compared with moderate-dose statins, intensive statin therapy can reduce major adverse cardiac events among patients with acute coronary syndrome (ACS). However, the results of intensive-versus-moderate lipid-lowering therapy after PCI for ACS are not well established. Furthermore, no studies have compared the effect of different statin dosages on target vessel revascularization (TVR) and non-TVR. In this patient subgroup, clinicians often focus on treating the stent rather than the whole patient. Stenting only treats one focal spot, not the whole bed of the coronary tree. Clopidogrel and aspirin are often used to keep the stent open, but the role of intensive lipid-lowering therapy in PCI is frequently undervalued. Support for Intensive Lipid Lowering In the December 8, 2009 Journal of the American College of Cardiology, my colleagues and I conducted a study in which we compared outcomes in 2,868 patients who underwent PCI for ACS just prior to enrollment in the PROVE IT–TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22) trial. The PROVE IT–TIMI 22 randomized ACS patients to either 80 mg atorvastatin or 40 mg pravastatin daily. Of the original cohort, 69% had undergone PCI just prior to randomization. The incidence of the primary composite end point of all-cause mortality, myocardial infarction, unstable angina leading to hospitalization, and revascularization after 30 days and stroke was evaluated. We also assessed the incidence of TVR and non-TVR during follow-up. Treatment with 80 mg atorvastatin reduced the incidence of the composite end point (21.5% vs 26.5%) and lowered the incidence of TVR (11.4% vs 15.4%) and non-TVR (8.0% vs 10.5%) when compared with...