术前他汀类药物治疗和肌钙蛋白T可预测冠状动脉手术的早期并发症。

Preoperative statin therapy and troponin T predict early complications of coronary artery surgery.

作者信息

Pascual Domingo A, Arribas Jose M, Tornel Pedro L, Marín Francisco, Oliver Clara, Ahumada Miguel, Gomez-Plana Jesus, Martínez Pedro, Arcas Ramón, Valdes Mariano

机构信息

Department of Cardiology, Hospital Universitario Arrixaca, Murcia, Spain.

出版信息

Ann Thorac Surg. 2006 Jan;81(1):78-83. doi: 10.1016/j.athoracsur.2005.07.038.

DOI:10.1016/j.athoracsur.2005.07.038

PMID:16368340

Abstract

BACKGROUND

Pretreatment with statins reduces early ischemic events after percutaneous coronary interventions, primarily in patients with a high level of inflammation markers. We sought to examine the association between preoperative statin therapy, systemic inflammation, and myocardial ischemia with the occurrence of early cardiac complications after coronary artery bypass grafting surgery.

METHODS

One hundred forty-one consecutive patients who underwent coronary artery bypass grafting surgery from two university tertiary hospitals were stratified according to their preoperative status of statin therapy (87 treated and 54 nontreated). Preoperative blood samples were collected for measurement of lipid parameters, C-reactive protein, interleukin-6, and troponin T. The evaluated primary endpoint was a composite of death and myocardial infarction at 30 days.

RESULTS

Patients undergoing preoperative statin therapy showed a reduced incidence of death (2.3% versus 13.0%, p = 0.012), myocardial infarction (5.7% versus 18.5%, p = 0.017), and primary combined endpoint (8.0% versus 22.2%, p = 0.017). In the multivariate model, preoperative troponin T greater than 0.01 ng/mL (odds ratio 6.85, p = 0.001) and nonstatin therapy (odds ratio 4.2, p = 0.01) predicted a higher risk of primary endpoint. Statins showed a significant interaction with troponin T status and benefited primarily those patients with positive troponin T. Among 19 patients with troponin T greater than 0.01 ng/mL, the primary endpoint occurred in all 6 nonstatin-treated patients, but it occurred in only 1 of 13 statin-treated patients (p < 0.001). Neither C-reactive protein nor interleukin-6 predicted early complications, nor did they interact with statin therapy (p = not significant).

CONCLUSIONS

Preoperative statin therapy reduces early complications and offers additional protection in patients with positive troponin T status, regardless of inflammatory markers.

摘要

背景

他汀类药物预处理可降低经皮冠状动脉介入治疗后的早期缺血事件，主要适用于炎症标志物水平较高的患者。我们试图研究冠状动脉旁路移植术后术前他汀类药物治疗、全身炎症和心肌缺血与早期心脏并发症发生之间的关联。

方法

从两家大学三级医院连续选取141例行冠状动脉旁路移植术的患者，根据术前他汀类药物治疗状态进行分层（87例接受治疗，54例未接受治疗）。采集术前血样以测定血脂参数、C反应蛋白、白细胞介素-6和肌钙蛋白T。评估的主要终点是30天时的死亡和心肌梗死复合终点。

结果

术前接受他汀类药物治疗的患者死亡发生率降低（2.3%对13.0%，p = 0.012），心肌梗死发生率降低（5.7%对18.5%，p = 0.017），主要复合终点发生率降低（8.0%对22.2%，p = 0.017）。在多变量模型中，术前肌钙蛋白T大于0.01 ng/mL（比值比6.85，p = 0.001）和未接受他汀类药物治疗（比值比4.2，p = 0.01）预示着主要终点风险较高。他汀类药物与肌钙蛋白T状态存在显著交互作用，主要使肌钙蛋白T阳性的患者受益。在19例肌钙蛋白T大于0.01 ng/mL的患者中，所有6例未接受他汀类药物治疗的患者均发生了主要终点事件，但13例接受他汀类药物治疗的患者中仅1例发生（p < 0.001）。C反应蛋白和白细胞介素-6均未预测早期并发症，它们与他汀类药物治疗也无交互作用（p = 无显著性差异）。