American heart journal plus : cardiology research and practice · 2025
Differential effects of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory markers in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized controlled trial.
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Khameneh Bagheri Ramin, Eshraghi Ali, Amirsoleimani Hasan, Keihanian Faeze
Аннотация
BACKGROUND: The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).
METHODS: In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)-were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.
RESULTS: The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2-8.1] vs. 7.8 [4.9-10.2], p = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, p < 0.001). No significant inter-group difference was found in the 48-h PLR.
CONCLUSION: While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.Registry Accessibility: http://irct.ir/trial/27377Trial registration code: IRCT2017101236737N1.
METHODS: In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)-were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.
RESULTS: The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2-8.1] vs. 7.8 [4.9-10.2], p = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, p < 0.001). No significant inter-group difference was found in the 48-h PLR.
CONCLUSION: While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.Registry Accessibility: http://irct.ir/trial/27377Trial registration code: IRCT2017101236737N1.