Date of Graduation

Summer 8-9-2014

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte MD

Abstract

Background: Many patients with acute coronary syndrome in the United States electively choose to undergo percutaneous coronary angioplasty. One of the many risks associated with this procedure is peri-procedural myocardial infarction (MI). Recently, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors otherwise known as statins administered before the procedure have been shown to reduce the incidence of peri-procedural myocardial infarction. Many of the studies that have been done have used atorvastatin and have been limited to peri-procedural outcomes. Will administering a loading dose of rosuvastatin before percutaneous coronary intervention (PCI) improve mid and long term outcomes?

Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, EBSCO, CINAHL, Health Source-Consumer, and Web of Science using the keywords: rosuvastatin and percutaneous coronary intervention. Relevant articles were assessed for quality using GRADE.

Results: Three studies, with one including a 12-month follow up study met inclusion criteria. A prospective randomized trial of 445 patients that included a 12-month follow up study concluded that a 40mg loading dose of rosuvastatin before PCI improved 12-month clinical outcomes. A single center, prospective, randomized trial of 160 patients demonstrated that a 40mg loading dose of rosuvastatin before elective PCI decreased the incidence of postprocedural MI during a period of 12 months compared to standard treatment. A randomized, prospective, double-blind, placebo-controlled trial of 125 patients concluded that a 20mg loading dose of rosuvastatin before PCI reduces the incidence of postprocedural MI in patients with acute coronary syndrome.

Conclusion: A loading dose of rosuvastatin has been shown to reduce the incidence of both myocardial infarction and major adverse cardiac events up to 12 months post-procedure. More research is needed to discover the exact mechanism of action. Furthermore, more research is needed to address the correct dosing, timing of administration, and whether or not rosuvastatin is better than other statins in the setting of PCI. Lastly, can patients with ST-elevation myocardial infarctions undergoing PCI benefit from the same treatment?

Keywords: Rosuvastatin and percutaneous coronary intervention

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