Khanal Sanjaya, Attallah Nizar, Smith Dean E, Kline-Rogers Eva, Share David, O'Donnell Michael J, Moscucci Mauro
Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, Mich 48202, USA.
Am J Med. 2005 Aug;118(8):843-9. doi: 10.1016/j.amjmed.2005.03.031.
We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown.
We studied 29409 patients who had both baseline preprocedure and peak postprocedure serum creatinine measured at the time of their percutaneous coronary intervention (PCI). Baseline demographics and creatinine profile before and after the procedure were compared between patients who received preprocedure statins and those who did not. CIN was defined as an increase in serum creatinine of < or =0.5 mg/dL.
Baseline serum creatinine was similar between the two groups. When compared with patients who did not receive preprocedure statins, patients on preprocedure statins had a lower incidence of CIN (4.37 vs 5.93, P <0.0001) and nephropathy requiring dialysis (0.32 vs 0.49, P = 0.03). After adjustments for comorbidities, preprocedure statin use was associated with a significant reduction in CIN (odds ration [OR] 0.87, 95% confidence interval [CI] 0.77-0.99, P = 0.03).
Preprocedure statin use is associated with significant reduction in CIN after contemporary PCI. This reinforces the need to initiate statin therapy before percutaneous coronary interventions.
我们试图研究经皮冠状动脉介入治疗前使用他汀类药物治疗是否能降低造影剂肾病（CIN）的发生率。血管内注射造影剂可产生肾毒性作用，尤其是在基线肾功能不全的患者中。除了降低血清胆固醇外，他汀类药物在血管系统中具有多效性作用。他汀类药物使用对CIN的影响尚不清楚。
我们研究了29409例在经皮冠状动脉介入治疗（PCI）时测量了术前基线和术后肌酐峰值的患者。比较了术前接受他汀类药物治疗的患者和未接受他汀类药物治疗的患者的基线人口统计学特征以及术前和术后的肌酐情况。CIN定义为血清肌酐升高≥0.5mg/dL。
两组患者的基线血清肌酐相似。与未接受术前他汀类药物治疗的患者相比，接受术前他汀类药物治疗的患者CIN发生率较低（4.37%对5.93%，P<0.0001），需要透析的肾病发生率也较低（0.32%对0.49%，P = 0.03）。在对合并症进行调整后，术前使用他汀类药物与CIN的显著降低相关（优势比[OR]为0.87，95%置信区间[CI]为0.77-0.99，P = 0.03）。
在当代PCI术后，术前使用他汀类药物与CIN的显著降低相关。这进一步强调了在经皮冠状动脉介入治疗前启动他汀类药物治疗的必要性。
