Briguori Carlo, Colombo Antonio, Airoldi Flavio, Violante Anna, Focaccio Amelia, Balestrieri Pasquale, Paolo Elia Pietro, Golia Bruno, Lepore Stefano, Riviezzo Guido, Scarpato Pierfranco, Librera Mariateresa, Bonizzoni Erminio, Ricciardelli Bruno
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio 2, I-80121 Naples, Italy.
Eur Heart J. 2004 Oct;25(20):1822-8. doi: 10.1016/j.ehj.2004.07.017.
Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI.
Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure.Incidence of peri-procedural myocardial injury was assessed by analysis of creatinine kinase myocardial isoenzyme (CK-MB: upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (cTn I, ULN 0.10 ng/ml) before, 6 and 12 h after the intervention. A large non-Q-wave myocardial infarction was defined as a CK-MB elevation >5 times ULN alone or associated with chest pain or ST segment or T wave abnormalities. Median CK-MB peak after PCI was 1.70 (interquartile ranges 1.10-3.70) ng/ml in the Statin group and 2.20 (1.30-5.60) ng/ml in the Control group (p=0.015). Median peak of cTnI after PCI was 0.13 (0.05-0.45) ng/ml in the Statin group and 0.21 (0.06-0.85) ng/ml in the Control group (p=0.033). The incidence of a large non-Q-wave myocardial infarction was 8.0% in the Statin group and 15.6% in the Control group (p=0.012: OR=0.47; 95% CI=0.26-0.86). The incidence of cTnI elevation >5 times ULN was 23.5% in the Statin group and 32% in the Control group (p=0.043: OR=0.65; 95% CI=0.42-0.98). By logistic regression analysis, the independent predictors of CK-MB elevation >5 times ULN after PCI were intra-procedural angiographic complications (OR=9.36; 95% CI=3.06-28.64; p<0.001), statin pre-treatment (OR=0.33; 95% CI=0.13-0.86; p=0.023) and age >65 years (OR=2.58; 95% CI=1.09-6.11; p=0.031).
Pre-procedural statin therapy reduces the incidence of large non-Q-wave myocardial infarction after PCI.
围手术期非Q波心肌梗死是经皮冠状动脉介入治疗（PCI）常见且对预后有重要影响的并发症。据推测，他汀类药物可能降低PCI后心肌损伤的发生率。
451例计划接受择期PCI且未服用他汀类药物的患者被随机分为未治疗组或他汀类药物治疗组。他汀类药物在手术前至少3天开始使用。通过分析干预前、干预后6小时和12小时的肌酸激酶心肌同工酶（CK-MB：正常上限[ULN]为3.5 ng/ml）和心肌肌钙蛋白I（cTn I，ULN为0.10 ng/ml）评估围手术期心肌损伤的发生率。大面积非Q波心肌梗死定义为CK-MB升高>正常上限5倍，单独出现或伴有胸痛、ST段或T波异常。他汀类药物组PCI后CK-MB峰值中位数为1.70（四分位间距1.10 - 3.70）ng/ml，对照组为2.20（1.30 - 5.60）ng/ml（p = 0.015）。他汀类药物组PCI后cTnI峰值中位数为0.13（0.05 - 0.45）ng/ml，对照组为0.21（0.06 - 0.85）ng/ml（p = 0.033）。他汀类药物组大面积非Q波心肌梗死的发生率为8.0%，对照组为15.6%（p = 0.012；OR = 0.47；95% CI = 0.26 - 0.86）。cTnI升高>正常上限5倍的发生率在他汀类药物组为23.5%，对照组为32%（p = 0.043；OR = 0.65；95% CI = 0.42 - 0.98）。通过逻辑回归分析，PCI后CK-MB升高>正常上限5倍的独立预测因素为术中血管造影并发症（OR = 9.36；95% CI = 3.06 - 28.64；p < 0.001）、他汀类药物预处理（OR = 0.33；95% CI = 0.13 - 0.86；p = 0.023）和年龄>65岁（OR = 2.58；95% CI = 1.09 - 6.11；p = 0.031）。
术前他汀类药物治疗可降低PCI后大面积非Q波心肌梗死的发生率。
