[急性心肌梗死患者经皮冠状动脉介入治疗成功后他汀类药物治疗的早期启动]

[Early initiation of statin therapy in patients with acute myocardial infarction after successful percutaneous coronary intervention].

作者信息

Katayama Naoyuki, Nakao Koichi, Horiuchi Kenji, Ogawa Hisao, Honda Takashi

机构信息

Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto.

出版信息

J Cardiol. 2004 Oct;44(4):131-40.

PMID:15532243

Abstract

OBJECTIVES

To evaluate the effect of statins on the prognosis of acute myocardial infarction after percutaneous coronary intervention (PCI).

METHODS

We reviewed 280 patients with acute myocardial infarction who underwent PCI within 12 hr after the onset of symptoms. Statin therapy was initiated in 72 patients within 8.6 +/- 7.6 days after the onset (statin group) but not in the remaining 208 (no statin group). The time sequential changes of low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) levels, and the angiographic findings at 6 months after PCI were compared.

RESULTS

At onset, LDL-C levels in the statin group were significantly higher than those in the no statin group (140 +/- 35 vs 118 +/- 28 mg/dl, p < 0.01). However, at restudy, the values were similar between the two groups (113 +/- 19 vs 118 +/- 21 mg/dl, p = 0.19). CRP levels at restudy tended to be lower in the statin group than in the no statin group (0.11 +/- 0.12 vs 0.14 +/- 0.13 mg/dl, p = 0.07). Although the binary restenosis rates of the culprit lesion were almost equivalent (statin group 29% vs no statin group 23%, p = 0.30), new lesions in the non-culprit vessels tended to be found more frequently in the no statin group than in the statin group (13% vs 4%, p = 0.07). CRP levels at restudy were significantly higher in the patients with new lesions (n = 27) than in those without (n = 253; 0.25 +/- 0.17 vs 0.11 +/- 0.19 mg/dl, p < 0.01), whereas LDL-C levels were similar between the two groups (117 +/- 20 vs 113 +/- 27 mg/dl, p = 0.75). LDL-C, CRP at restudy and the rates of new lesions were similar in the patients receiving water-soluble statins (n = 42) and liposoluble statins (n = 30).

CONCLUSIONS

Statin therapy initiated at the early phase of acute myocardial infarction might prevent the development of new lesions in non-culprit vessels without any influence on the restenosis rate of the culprit lesion.

摘要

目的

评估他汀类药物对经皮冠状动脉介入治疗（PCI）后急性心肌梗死预后的影响。

方法

我们回顾了280例症状发作后12小时内接受PCI的急性心肌梗死患者。72例患者在症状发作后8.6±7.6天内开始他汀类药物治疗（他汀类药物组），其余208例未接受治疗（非他汀类药物组）。比较PCI后6个月时低密度脂蛋白胆固醇（LDL-C）和C反应蛋白（CRP）水平的时间序列变化以及血管造影结果。

结果

发病时，他汀类药物组的LDL-C水平显著高于非他汀类药物组（140±35 vs 118±28 mg/dl，p<0.01）。然而，复查时，两组的值相似（113±19 vs 118±21 mg/dl，p = 0.19）。复查时，他汀类药物组的CRP水平倾向于低于非他汀类药物组（0.11±0.12 vs 0.14±0.13 mg/dl，p = 0.07）。尽管罪犯病变的二元再狭窄率几乎相当（他汀类药物组29% vs非他汀类药物组23%，p = 0.30），但非罪犯血管中的新病变在非他汀类药物组中比在他汀类药物组中更频繁地被发现（13% vs 4%，p = 0.07）。有新病变的患者（n = 27）复查时的CRP水平显著高于无新病变的患者（n = 253；0.25±0.17 vs 0.11±0.19 mg/dl，p<0.01），而两组的LDL-C水平相似（117±20 vs 113±27 mg/dl，p = 0.75）。接受水溶性他汀类药物（n = 42）和脂溶性他汀类药物（n = 30）的患者复查时的LDL-C、CRP以及新病变发生率相似。