Tesis

Pengaruh Pemberian Atorvastatin Dosis Tinggi Sebelum Intervensi Koroner Perkutan Primer terhadap Perfusi Mikrovaskular = Effect of High Loading Dose of Atorvastatin Before Primary Percutaneus Coronary Intervention on Microvascular Perfusion in ST Elevation Myocardial Infarction Patients

Latar Belakang: Statin (3-hydroxy-3-methylglutaryl coenzyme A reductase
inhibitors) melalui efek pleiotrofiknya telah terbukti menurunkan angka kejadian
kardiovaskular mayor (KKM) setelah intervensi perkutan pada pasien angina
pektoris stabil maupun pasien sindroma koroner akut. Namun masih banyak
perdebatan mengenai manfaat statin segera sebelum dilakukan intervensi
perkutan primer (IKPP) pada pasien IMA-EST.
Tujuan: Untuk mengetahui pengaruh pemberian terapi akut atorvastatin dosis
tinggi (80 mg) dan plasebo sebelum IKPP terhadap perfusi mikrovaskular pada
pasien IMA-EST yang dinilai dengan teknik IRM (indeks resistensi
mikrovaskular). IRM merupakan pemeriksaan mikrovaskular yang spesifik dan
bersifat kuantitatif, dapat memberikan nilai prognostik dan prediktor perbaikan
fungsi ventrikel kiri setelah dilakukannya IKPP.
Metode: Penelitian ini merupakan studi eksperimental acak yang tersamar ganda.
Diberikan atorvastatin dosis 80 mg atau plasebo. Sampel diambil secara
consecutive dari populasi terjangkau IMA-EST yang menjalani IKPP dan
memenuhi kriteria inklusi dan eksklusi. Reperfusi miokardium dinilai dengan
parameter IRM dengan menggunakan kawat dengan sensor tekanan dan suhu
setelah IKPP selesai dilakukan.
Hasil Penelitian: Terdapat 66 sampel yang terbagi dalam 2 kelompok yakni 32
orang mendapatkan atorvastatin 80 mg dan 34 orang mendapatkan plasebo. Tidak
didapatkan perbedaan yang signifikan pada kelompok yang mendapatkan
atorvastatin 80 mg dan plasebo dalam hal parameter fractional flow reserve (FFR)
(0.94 vs. 0.96, p = 0.39), coronary flow reserve (CFR) (1.1 vs. 1.2, p = 0.09) dan
IRM (41.54 [12.8-198.2] vs. 41.60 [10.4 – 200.3], p = 0.61).
Kesimpulan: Pemberian terapi atorvastatin dosis tinggi 80 mg sebelum tindakan
IKPP pada pasien IMA-EST tidak memberikan pengaruh terhadap perfusi
mikrovaskular yang dinilai dengan parameter IMR.
Kata kunci: IMA-EST, IKPP, perfusi mikrovaskular, atorvastatin, IRM


Background: Statin (3-hydroxy-3-methylglutaryl coenzyme A reductase
inhibitors), given before percutaneous coronary intervention (PCI) was proven to
reduce Major Cardiovascular Events (MACE) in patient with stable angina as well
as acute coronary syndromes through its pleiotropic effect. Nevertheless, the
debate regarding statin administration before primary PCI (PPCI) in STEMI
patients is still on the rise.
Objective: To establish therapeutic effect of high dose atorvastatin (80 mg) and
placebo before primary PCI on microvascular perfusion in STEMI patient using
index of microcirculatory resistance (IMR). IMR are specific and quantitative
assessment of coronary microvascular dysfunction, reliable on-site predictors of
short-term myocardial viability and left ventricle functional recovery of patients
undergoing primary PCI for STEMI
Methods: This study is a double blind randomized controlled trial. A high
loading dose of atorvastatin (80 mg) or placebo was administered before PPCI.
Samples were taken from the population of STEMI patients which underwent
PPCI and meet the inclusion and exclusion criteria. The primary end point of this
study is IMR. After successful primary percutaneous coronary intervention, IMR
was measured using a pressure-temperature sensor-tipped coronary guidewire.
Result: Total of 66 patients was divided into 2 groups, atorvastatin group (32
patients) and placebo group (34 patients). There were no significant differences
between both groups in regard of fractional flow reserve (FFR) (0.94 vs. 0.96, p =
0.39), coronary flow reserve (CFR) (1.1 vs. 1.2, p = 0.09) and also IMR (41.54
[12.8-198.2] vs. 41.60 [10.4 – 200.3], p = 0.61).
Conclusion: Administration of high loading dose of atorvastatin (80 mg) before
primary PCI in STEMI patients didn’t have effect on microvascular perfusion
measured by index of microcirculatory resistance.
Keywords: STEMI, Primary PCI, microvascular perfusion, Atorvastatin, Index of
Microcirculatory Resistance (IMR)