Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.
Int J Cardiol. 2009 Nov 12;137(3):246-51. doi: 10.1016/j.ijcard.2008.06.055. Epub 2008 Aug 15.
Statin therapy prior to percutaneous coronary intervention (PCI) is associated with reduced mortality and periprocedural myocardial injury after PCI. We studied whether single high dose statin loading is beneficial on the outcome of patients with acute coronary syndrome (ACS) underwent PCI.
Consecutive 445 patients with ACS who underwent PCI were randomly assigned to either the group of no statin treatment before PCI (Control group: n=220, 63+/-11 years, male 62%) or the group of 40 mg rosuvastatin loading before PCI (Rosuvastatin group: n=225, 64+/-10 years, male 60%). Incidence of periprocedural myocardial injury was assessed by analysis of creatinine kinase-MB (CK-MB) and cardiac troponin T before PCI, at 6 h and the next morning after PCI.
There were no significant differences in clinical characteristics between the two groups. After PCI, incidence of periprocedural myocardial injury was higher in control than in rosuvastatin group (11.4% versus 5.8%, p=0.035). Mean preprocedural CK-MB and high sensitivity C-reactive protein were similar between the two groups, whereas after PCI, peak values of both markers were elevated significantly higher in control than in rosuvastatin group. Multivariate analysis revealed that no prior use of statin (OR=2.2; 95% CI=1.1-4.6; p=0.029), procedural complication (OR=3.1; 95% CI=1.4-6.9; p=0.007) and multi-vessel disease (OR=2.6; 95% CI=1.0-6.6; p=0.039) were the independent predictors for periprocedural myocardial infarction.
Single high dose of rosuvastatin prior to PCI reduces periprocedural myocardial injury in patients with ACS.
经皮冠状动脉介入治疗（PCI）前应用他汀类药物治疗可降低死亡率和 PCI 后的围手术期心肌损伤。我们研究了在接受 PCI 的急性冠状动脉综合征（ACS）患者中，单次大剂量他汀类药物负荷是否有益。
连续纳入 445 例接受 PCI 的 ACS 患者，随机分为 PCI 前无他汀类药物治疗组（对照组：n=220，63±11 岁，男性 62%）或 PCI 前给予 40mg 瑞舒伐他汀负荷剂量组（瑞舒伐他汀组：n=225，64±10 岁，男性 60%）。通过 PCI 前、PCI 后 6 小时和次日清晨的肌酸激酶同工酶-MB（CK-MB）和心肌肌钙蛋白 T 分析评估围手术期心肌损伤的发生率。
两组患者的临床特征无显著差异。与瑞舒伐他汀组相比，对照组 PCI 后围手术期心肌损伤发生率较高（11.4%比 5.8%，p=0.035）。两组患者的 PCI 前 CK-MB 和高敏 C 反应蛋白均值相似，而 PCI 后两组标志物的峰值均显著升高，对照组明显高于瑞舒伐他汀组。多变量分析显示，PCI 前未使用他汀类药物（OR=2.2；95%CI=1.1-4.6；p=0.029）、手术并发症（OR=3.1；95%CI=1.4-6.9；p=0.007）和多血管病变（OR=2.6；95%CI=1.0-6.6；p=0.039）是围手术期心肌梗死的独立预测因素。
PCI 前单次给予大剂量瑞舒伐他汀可减少 ACS 患者围手术期心肌损伤。
