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The Effect of Statins on the No-Reflow Phenomenon

An Observational Study in Patients with Hyperglycemia before Primary Angioplasty

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Abstract

Background

An association between admission plasma glucose levels and an increased risk of no-reflow has been well documented. Although HMG-CoA reductase inhibitor (statin) therapy can reduce no-reflow, little is known about its effect on no-reflow in patients with hyperglycemia. In the present study, we investigated whether pretreatment with a statin could reduce no-reflow in patients with hyperglycemia, who underwent primary coronary intervention for acute myocardial infarction (AMI).

Methods

A total of 259 consecutive patients who underwent primary angioplasty for a first AMI were studied. Blood glucose and creatinine kinase levels were measured on admission. All patients underwent 2-dimensional echocardiography and electrocardiographic analysis just after admission. No-reflow was defined as a Thrombolysis in Myocardial Infarction (TIMI) flow grade <3. Hyperglycemia was defined as a blood glucose level ≥10 mmol/L. Statin administration prior to admission was determined by detailed interview or information in the medical records.

Results

Hyperglycemia was diagnosed in 154 patients on admission. The no-reflow phenomenon was found in 31 of the 154 patients with hyperglycemia. The incidence of no-reflow was significantly greater in patients with hyperglycemia compared with no hyperglycemia. A multivariable logistic regression analysis showed that hyperglycemia on admission was an independent predictor of no-reflow. Among the 154 patients with hyperglycemia, there were no significant differences in baseline clinical characteristics between patients who received statin pretreatment and those who did not; however, hyperlipidemia occurred in a greater number of the patients who did not receive statin pretreatment. The 40 patients with hyperglycemia who received statins before admission had a lower incidence of no-reflow than those who did not receive statin pretreatment (5% and 25.4%; p < 0.05). Multivariable logistic regression analysis revealed that absence of statin pretreatment was a significant predictor of no-reflow in patients with hyperglycemia, along with ejection fraction on admission, initial TIMI 0 flow, number of Q waves, and anterior AMI.

Conclusion

The results of our study show that pretreatment with statins could attenuate no-reflow after AMI in patients with acute hyperglycemia.

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Acknowledgments

This study was supported, in part, by a grant-in-aid (30572439) from the National Natural Science Foundation of China. The authors have no conflicts of interest directly relevant to the contents of this study.

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Authors and Affiliations

  1. Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Jing-Lin Zhao,  Yue-Jin Yang, Wei-Dong Pei, Yu-Hua Sun & Ji-Lin Chen

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  1. Jing-Lin Zhao
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  2. Yue-Jin Yang
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  3. Wei-Dong Pei
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Correspondence to Yue-Jin Yang.

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Zhao, JL., Yang, YJ., Pei, WD. et al. The Effect of Statins on the No-Reflow Phenomenon. Am J Cardiovasc Drugs 9, 81–89 (2009). https://doi.org/10.1007/BF03256579

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