O.M. Parkhomenko, O.I. Irkin, Ya.M. Lutai, S.P. Kushnir,D.О. Bilyi, A.O. Stepura, Yu.M. Sokolov, M.Yu. Sokolov, V.Yu. Kobylyak, A.S. Kryvchun Effect of various regimens of lipid-lowering therapy on the efficacy of urgent myocardial revascularization and development of left ventricular remodeling in patients with acute coronary syndrome with ST segment elevation

The aim – to evaluate the effect of different regimes of lipid lowering therapy on the effectiveness of urgent myocardial revascularization and the development of cardiac remodeling in patients with acute coronary syndrome with ST segment elevation (STEMI).

Material and methods. The study involved 135 STEMI patients admitted an average of 4.5 hours after symptoms onset and treated with primary percutaneous intervention. Lipid-lowering treatment was prescribed immediately after presentation. Patients were randomly assigned to one of four groups treated by moderate (group I and group II) or high (group III and group IV) intensity lipid-lowering therapy. Group I (26 patients) was assigned to atorvastatin 10 mg / ezetimibe 10 mg combination, group II (24 patients) – to atorvastatin 40 mg, group III (42 patients) – to atorvastatin 40 mg / ezetimibe 10 mg combination, and group IV (43 patients) – to atorvastatin 80 mg. Echocardiography was performed in all the patients during first 24 hours after symptoms onset and 90 days after STEMI development. Left ventricular (LV) dilatation was defined as at least 25 % increase of end-diastolic volume.

Results. Patients from groups III and IV showed a tendency to the reduction of post-MI LV dilatation after 3 month of treatment (Р<0.1). In our study use of high intensity lipid-lowering therapy reduced the risk of LV remodeling by 30 % (p<0.05), that was also associated with significantly higher LDL reduction. Having no initial differences, on the 90th day the average LDL level was 1.63±0.40 in patients with high intensity treatment vs. 2.21±0.30 mmol/l in patient with therapy of moderate intensity (Р<0.01). Conclusion. The use of high-intensity lipid-lowering therapy with achievement of target LDL levels after STEMI can reduce the incidence of post-MI LV dilatation.

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