Mulukutla Suresh R, Marroquin Oscar C, Smith Conrad, Varghese Rekhi, Anderson William D, Lee Joon S, Cohen Howard A, Counihan Peter J, Lee Ashley B, Gulati Vijay, McNamara Dennis
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Am J Cardiol. 2004 Dec 1;94(11):1363-6. doi: 10.1016/j.amjcard.2004.07.140.
This study evaluated whether pretreatment with statins was associated with a decreased incidence of periprocedural myocardial injury. Periprocedural myocardial injury occurs after percutaneous coronary intervention (PCI) and is associated with adverse outcomes. The pleiotropic properties of statins stabilize plaque and decrease the inflammatory milieu of atherosclerotic lesions. Accordingly, we hypothesized that preprocedural statin therapy would decrease periprocedural myocardial injury. We enrolled 425 patients who underwent successful PCI. The control arm (n = 150) included patients not on statin therapy at the time of PCI, and the statin arm (n = 275) included patients who were taking statin medication before PCI. All patients had serial enzymes measured, including creatine kinase (CK), CK-MB, and troponin I. The incidence of increased levels of CK and CK-MB >3 times normal and the absolute increase in CK and troponin I were compared between groups. The control arm had significantly higher periprocedural levels of CK. In the control group, 6% of patients had CK increases >3 times the upper limit of normal compared with 1.8% in the statin group (p = 0.02). The control arm had a higher frequency of CK-MB increases >3 times the upper limit of normal (7.3% vs 2.2%, p = 0.01). There was a trend toward higher levels of troponin I in the control group (3.21 vs 1.85 ng/ml, p = 0.06). Thus, statin therapy before elective PCI was associated with lower levels of periprocedural CK.
本研究评估了他汀类药物预处理是否与围手术期心肌损伤发生率降低相关。围手术期心肌损伤发生于经皮冠状动脉介入治疗（PCI）后，且与不良预后相关。他汀类药物的多效性可稳定斑块并减少动脉粥样硬化病变的炎症环境。因此，我们推测术前他汀类药物治疗可降低围手术期心肌损伤。我们纳入了425例成功接受PCI的患者。对照组（n = 150）包括PCI时未接受他汀类药物治疗的患者，他汀组（n = 275）包括PCI术前正在服用他汀类药物的患者。所有患者均进行了系列酶检测，包括肌酸激酶（CK）、CK-MB和肌钙蛋白I。比较两组CK和CK-MB水平升高超过正常上限3倍的发生率以及CK和肌钙蛋白I的绝对升高值。对照组围手术期CK水平显著更高。在对照组中，6%的患者CK升高超过正常上限的3倍，而他汀组为1.8%（p = 0.02）。对照组CK-MB升高超过正常上限3倍的频率更高（7.3%对2.2%，p = 0.01）。对照组肌钙蛋白I水平有升高趋势（3.21对1.85 ng/ml，p = 0.06）。因此，择期PCI术前的他汀类药物治疗与围手术期较低的CK水平相关。
