Low-dose versus moderate-dose atorvastatin after acute myocardial infarction: 8-Month effects on coronary flow reserve and angiogenic cell mobilisation

Objective: To compare the effects of atorvastatin 10 mg versus 40 mg in circulating angiogenic cell mobilisations and in restoring coronary flow reserve (CFR) during the 8-month follow-up in patients with a first acute myocardial infarction (AMI). Design: CFR was measured using an intracoronary Doppler wire in 102 patients with AMI at baseline and at 8 months. Changes in the absolute number of circulating angiogenic cells were measured at baseline, 1 day, 5 days and at 8 months. Stented patients were randomly assigned to either low-dose atorvastatin 10 mg (ATOR10, n=52) or moderate-dose atorvastatin 40 mg (ATOR40, n=50). Setting: University Hospital. Results: CFR increased significantly in both groups during the 8-month follow-up. The 8-month increases from baseline in CFR were significantly greater in the ATOR40 group than in the ATOR10 group (0.99±0.69 vs 0.55±0.47, p=0.017, respectively). The serial increases in the absolute number of CD34+ and CXCR4+ cells were significantly greater in the ATOR40 group, especially at 24 h after the procedure (two-way repeated-measures analysis of variance: p=0.046 and p=0.022, respectively). Decreases from baseline for interleukin 6 (-2.94±3.31 vs -1.52±2.82 pg/ml), tumour necrosis factor α (-1.31±2.96 vs -0.01±1.29 pg/ml), soluble intercellular adhesion molecule-1 (-71±95 vs 37±83 ng/ml) and soluble vascular cell adhesion molecule-1 (-51±364 vs 190±204 ng/ml) were significantly greater in the ATOR40 group. Conclusions: The recovery of microvascular integrity after acute ischaemic injury in the ATOR40 group was expedited by greater circulating angiogenic cell mobilisations such as CD34+ and CXCR4+ cells, together with greater decreases in inflammatory cytokines and low-density lipoprotein- cholesterol concentrations. Registration number: http://ClinicalTrials.gov number, NCT00536887.