Background:
Circulating bone marrow-derived stem cells are capable of homing to sites of myocardial infarction and endothelial disruption, thereby restoring myocardial function and microvascular integrity after acute myocardial infarction. We compared the effects of atorvastatin 10 mg versus 40 mg in follow-up clinical events and in restoring coronary flow reserve (CFR) during the 8 months follow-up in patients with acute myocardial infarction.
Methods:
CFR, which is reflective of the integrity of coronary microvasculature, was measured by using intracoronary Doppler wire in 102 consecutive patients with acute myocardial infarction 5 days after the successful primary coronary intervention with sirolimus-eluting stents. Stented patients were randomly assigned to either atorvastatin 10 mg (ATOR10, n=52) or atorvastatin 40 mg (ATOR40, n=50). All patients received aspirin and clopidogrel. Clinical events such as death, myocardial infarction, and target lesion revascularization (TLR) were compared during the 8-month follow-up.
Results:
CFR increased significantly in both groups during the 8 months follow-up (1.9 ± 0.6 at baseline vs. 2.6 ± 0.7 at follow-up in the ATOR10, p<0.05; 1.9 ± 0.7 at baseline vs. 2.9 ± 0.8 at follow-up in the ATOR40, p<0.05). The changes from baseline in CFR was greater in the ATOR40 Group compared with the ATOR10 Group (1.0 ± 0.8 vs. 0.7 ± 0.6, p<0.05, respectively). The numbers of CD34+ and CXCR4+ cells were significantly greater in the ATOR40 Group compared with the ATOR10 Group (13 ± 10 vs. 6 ± 6, p<0.05, respectively for CD34 cells and 15 ± 14 vs. 10 ± 9, p<0.05, respectively for CXCR4+ cells per 1uL). Clinical events such as death (0 patient in the ATOR10 vs. 2 patients in the ATOR40, p=0.247), myocardial infarction (2 patients in the ATOR10 vs. 1 patient in the ATOR40, p=0.557), and TLR (2 patients in the ATOR10 vs. 2 patients in the ATOR40, p=0.692) demonstrated no significant differences during the follow-up.
Conclusion:
The increases from baseline in CFR, CD34+ cells and CXCR4+ cells were significantly greater in the ATOR40 Group compared with the ATOR10 Group. However, the improvement in left ventricular systolic function and the rate of clinical events revealed no significant differences between the 2 groups.
622 Noninvasive assessment of coronary flow reserve after elective stenting in patients with previous myocardial infarction: Relation to left ventricular recovery
