Microcirculation In Acute Coronary Syndromes

Impairment of the myocardial microcirculation in the setting of AMI is multifactorial in etiology. This may be due to vasoactive factors including endothelin-1, which is a potent vasoconstricting peptide and increasingly expressed in the active plaque . Oxidative stress and ischaemia per se may also reduce the bioavailability of nitric oxide, further contributing to the dysfunction of the myocardial microcirculation.

Statins have been shown to benefit ACS patients in that they are believed to decrease reperfusion injury after an ischemic event, promote plaque stabilization, and reduce inflammation in ACS patients. In patients admitted with acute coronary syndrome (ACS), treatment with statins <24 hours of presentation was associated with lower incidences of death, stroke, reinfarction, heart failure, and pulmonary edema compared with delayed administration .

40 statin naive patients admitted with STEMI will receive high dose statin Rosuvastatin 40 mg pre/per primary PCI and continue this treatment during the hospital stay. The high dose of rosuvastatin is chosen to achieve high plasma concentration as early as possible for per conditioning of the myocardium at risk. At discharge they will be switched to standard dose statin.

Myocardial infarction will be assessed with Contrast enhanced cardiac magnetic resonance at 2 days and at 2 months. Microvascular obstruction (MO) may be assessed by first- pass perfusion (FPP) and delayed hyper enhancement (DHE) MO is defined as regional hypoperfusion on first-pass perfusion as previously described . The investigators have recently demonstrated that MO as verified by CMR following MI may allow early identification of patients with a high risk of LV remodeling likely to benefit from pharmacological therapy .

Blood tests for assessment of collagen turnover, neurohumoral activation and inflammation will be drawn daily during hospital stay.

The Results will be compared with the findings of statin naive patients from tha KOMPIS trial who were not treated with high dose pre and per operative statins

Inclusion criteria

• Age > 18 years
• Evidence of acute ST elevation myocardial infarct.
• Planned primary PCI procedure.
• Obtained written informed consent.
• "One vessel disease"

Exclusion criteria

• History of previous myocardial infarction
• History of valvular disease
• Ongoing therapy for hyperlipidemia
• History of heart failure
• Any active non-cardiac co-morbidity or condition that is likely to compromise patient cooperation or survival during the follow-up period of the study.
• Pregnancy (In doubt a urine test will be employed before treatment)
• Lactating females
• Asians
• Previous muscle disease
• Reduced glomerular filtration
• Active hepatic disease
• Ongoing oral anticoagulation therapy
• Ongoing cyclosporine therapy