Key result
Single-dose atorvastatin significantly reduced the mean area of no-reflow compared to the AMI/R control group (47.01% vs 85.67% of ligation area; P<0.01) in a rabbit model.
Why the study?
Does single-dose atorvastatin reduce inflammation and myocardial no-reflow in a rabbit model of acute myocardial infarction and reperfusion?
RCT (n=24)
randomized
Does single-dose atorvastatin reduce inflammation and myocardial no-reflow in a rabbit model of acute myocardial infarction and reperfusion?
Absolute Event Rate: 47.01% vs 85.67%
p-value: p=<0.01
Single-dose atorvastatin reduced inflammation, myocardial no-reflow, and infarct size in a rabbit model of acute myocardial infarction and reperfusion.
Hypothesis-generating for no-reflow reduction in AMI; clinical trials needed before any practice change.
The mechanisms of statins relieving the no-reflow phenomenon and the effects of single-dose statins on it are not well known. This study sought to investigate the effects of inflammation on the no-reflow phenomenon in a rabbit model of acute myocardial infarction and reperfusion (AMI/R) and to evaluate the effects of single-dose atorvastatin on inflammation and myocardial no-reflow. Twenty-four New Zealand white male rabbits (5-6 months old) were randomized to three groups of eight: a sham-operated group, an AMI/R group, and an atorvastatin-treated group (10 mg/kg). Animals in the latter two groups were subjected to 4 h of coronary occlusion followed by 2 h of reperfusion. Serum levels of interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay. The expression of interferon gamma (IFN-γ) in normal and infarcted (reflow and no-reflow) myocardial tissue was determined by immunohistochemical methods. The area of no-reflow and necrosis was evaluated pathologically. Levels of serum IL-6 were significantly lower in the atorvastatin group than in the AMI/R group (P<0.01). Expression of IFN-γ in infarcted reflow and no-reflow myocardial tissue was also significantly lower in the atorvastatin group than in the AMI/R group. The mean area of no-reflow [47.01% of ligation area (LA)] was significantly smaller in the atorvastatin group than in the AMI/R group (85.67% of LA; P<0.01). The necrosis area was also significantly smaller in the atorvastatin group (85.94% of LA) than in the AMI/R group (96.56% of LA; P<0.01). In a secondary analysis, rabbits in the atorvastatin and AMI/R groups were divided into two groups based on necrosis area (90% of LA): a small group (<90% of LA) and a large group (>90% of LA). There was no significant difference in the area of no-reflow between the small (61.40% of LA) and large groups (69.87% of LA; P>0.05). Single-dose atorvastatin protected against inflammation and myocardial no-reflow and reduced infarct size during AMI/R in rabbits. No-reflow was not dependent on the reduction of infarct size.
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Zhao et al. (2014) conducted an RCT in acute myocardial infarction and reperfusion (n=24). Atorvastatin vs. AMI/R group (no treatment) and sham-operated group was evaluated on mean area of no-reflow (% of ligation area) (p=<0.01). Single-dose atorvastatin significantly reduced the mean area of no-reflow compared to the AMI/R control group (47.01% vs 85.67% of ligation area; P<0.01) in a rabbit model.
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