The impact of Atorvastatin reload in patients undergoing percutaneous coronary intervention and its correlation with the toll-like receptors

The present study aims to evaluate the effect of pre percutaneous coronary intervention (PCI) atorvastatin reload on peripheral monocyte of toll-like receptor 2 and toll like receptor 4 expression and their correlation with cardiac injury markers (troponin I and creatine kinase Muscle brain isoenzyme) in a patient with stable angina. A double-blind randomized prospective trial in which 60 stable angina patients scheduled for an elective PCI were randomly allocated into two groups after, control group: 30 patients who received low dose atorvastatin 40 mg daily without reload. Atorvastatin reloads group: 30 patients who were already on the usual dose of atorvastatin with further 80 mg and 40 mg at 12 & 2 hrs. before PCI, respectively. TLR2 and TLR4 levels were assayed in peripheral monocyte by flow cytometry and cardiac troponin I, CK-MB, MCP-1 and HMG-box-1 protein were also measured before and at 4 hrs, 12 hrs after PCI. Stent implantation was associated with an elevation in TLR2 and TLR4 expression in peripheral monocyte in both study groups after stenting but significantly higher expression level was observed among the control group (P<0.05) at 4 hr and 12 hr post PCI. Inflammatory cytokine (HMG Box-1 protein MCP-1) were remarkably elevated after stenting in both. study groups (P < 0.005) but significantly higher in control group as compared to the atorvastatin reload group (P < 0. 0 5) also myocardial injury markers (CKMB, troponin I) were significantly higher in control group than atorvastatin reload group (P < 0. 0 5) there is a positive correlation between TLR2 and TLR4 expression with serum level of cardiac troponin I and CK-MB Atorvastatin reload before coronary artery interventions attenuate toll-like receptor 2 and 4 expressions on peripheral monocyte and significantly reduce serum level of HMG-box-1 protein, MCP-1 and cardiac injury markers (CK_MB and cardiac troponin I) and Increase peripheral monocyte expression of TLR2 and TLR4 associated with elevated serum level of cardiac injury markers (CK_MB and cardiac troponin I).