Nephrology Medical News about acute coronary syndrome, simvastatin, contrast-induced nephropathy, percutaneous coronary intervention

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Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention
The American Journal of Cardiology, 08/13/09

Xinwei J et al. – Pretreatment with simvastatin 80 mg before percutaneous coronary intervention (PCI) may further decrease the occurrence of contrast-induced nephropathy vs simvastatin 20 mg. This benefit was associated with lowering of high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels.

Methods

Study of protective effects of different statin doses on renal function
Assessment of 228 acute coronary syndrome pts undergoing selective PCI
Randomization into simvastatin 20-mg (S20, 115 pts) and simvastatin 80-mg (S80, 113 pts) groups
Measurement of serum creatinine at admission, day of PCI, and 24 and 48 hr after PCI
Calculation of creatinine clearance by Cochcroft-Gault formula
Measurement of high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 before/after procedure
Contrast-induced nephropathy defined as postprocedure increase in serum creatinine of ≥0.5 mg/dL or >25% from baseline

Results

Serum creatinine significantly increased after PCI; peak value at 24 hr; then decreased
At 48 hr, serum creatinine decreased to baseline level in S80 but not S20 group
At 24 and 48 hr after PCI, serum creatinine lower in S80 vs S20 group
Creatinine clearance significantly decreased after PCI; lowest value at 24 hr; then increased
In S80 group, creatinine clearance recovered to baseline level at 48 hr but not in S20 group
Creatinine clearance greater at 24 and 48 hr in S80 vs S20 group
Despite procedure causing significant increase in high-sensitive C-reactive protein, P-selectin, and intercellular adhesion molecule-1 levels, lower value in S80 vs S20 group

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