A randomized trial of creatine-kinase leak after rosuvastatin in elective percutaneous coronary intervention (CLEAR-PCI)

OBJECTIVES: To determine the impact of percutaneous coronary intervention (PCI) performed at the same time of the peak concentration of rosuvastatin to reduce periprocedural myocardial infarction (PMI). BACKGROUND: Prior studies suggest that a high dose of statin before PCI reduce periprocedural myocardial infarction. However, there is no information regarding the elective PCI performed at the time of the peak of statin concentration to reduce PMI. METHODS: From 2001 to 2013, at a single center in Brazil we enrolled 544 patients who underwent elective PCI and after exclusions for baseline biases in clinical and angiographic characteristics, yielding 528 patients, we prospectively randomly assigned them to either a high loading dose of Rosuvastatin before PCI (n = 264) or standard treatment (n = 264). After exclusions for biases in procedural characteristics a total of 487 patients underwent to end points analysis. The primary outcome was the incidence of MB fraction of creatine kinase (CK-MB) greater than three times the upper limit of normal.RESULTS:The primary end point occurred in 7.6% in the rosuvastatin and 4.8% in the control group (P = 0.200). There was a higher incidence in elevation of CK-MB than normal baseline in the rosuvastatin (67.1% vs 59.2%, P = 0.701). There was no difference in major adverse event (0% in the rosuvastatin group vs 0.8% in control).

[Acute reduction of blood pressure: comparative study of nifedipine and clonidine]. / Redução aguda da pressão arterial: estudo comparativo entre nifedipina e clonidina.

PURPOSE: To compare the efficacy of clonidine and nifedipine in rapidly reducing blood pressure (BP). PATIENTS AND METHODS: Forty-four patients with arterial hypertension of any cause were selected and randomly divided in three groups: P group, consisting of 9 patients who received placebo; N group, consisting of 17 patients, 8 males, mean age of 47 years who received 10 mg of sublingual nifedipine; C group, consisting of 18 patients, 6 males, with mean age of 47 years who received 0.2 mg of clonidine per os. The BP were measured on admission and every 15 minutes for 1 hour. The final goal of treatment was to lower diastolic pressure in 20 mmHg or more. RESULTS: At the end of 60 minutes the nifedipine as well as clonidine were equally effective in lowering BP. The earliest manifestation of drug activity occurred at 25 minutes after administration. Side effects were noted only with clonidine in 23% of the cases, but without any clinical significance. CONCLUSION: Nifedipine as well as clonidine are equally effective in rapidly lowering BP with minimal side effects.