Jia Xin-Wei, Fu Xiang-Hua, Zhang Jing, Gu Xin-Shun, Fan Wei-Ze, Wu Wei-Li, Hao Guo-Zhen, Li Shi-Qiang, Jiang Yun-Fa
Department of Cardiovascular Disease, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
Chin Med J (Engl). 2009 Mar 20;122(6):659-64.
The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention (PCI). This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.
Altogether 228 patients with acute coronary syndrome (ACS) were randomly assigned to standard statin group (SS group, n = 115) and intensive statin group (IS group, n = 113). Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Creatine kinase (CK) isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein (hs-CRP), P-selectin and intercellular adhesion molecule (ICAM) were measured before and 24 hours after the procedure.
The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group (all P < 0.05). Patients with no reflow phenomenon were less in the IS group (P < 0.001). The CTFC was lower in the IS group than in the SS group (P < 0.001). TMPG was also improved in the IS group than in the SS group (P = 0.001). Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group (18.74 +/- 8.41 vs 21.78 +/- 10.64, P = 0.018). Similar changes were also found in troponin I (0.99 +/- 1.07 in the IS group vs 1.47 +/- 1.54 in the SS group, P = 0.006). CK-MB elevation occurred in 27.8% (32/115) of the patients in the SS group vs 15.9% (18/113) in the IS group (P = 0.030). Myocardial necrosis was detected in 4.4% (5/115) of the patients in the SS group, whereas 0.9% (1/113) in the IS group (P = 0.341). But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group (36.5%, 42/115) than in the IS group (19.5%, 22/113) (P = 0.04). Among them, myocardial necrosis was detected in 13.0% (15/115) of the patients in the SS group, while 4.4% (5/113) in the IS group (P = 0.021). Myocardial infarction was found in 4.4% (5/115) of the patients in the SS group and 0.9% (1/113) in the IS group (P = 0.213).
Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.
无复流现象的发生率限制了经皮冠状动脉介入治疗（PCI）的临床疗效。本随机对照研究旨在评估强化他汀类药物预处理对PCI期间心肌灌注和心肌缺血损伤的即时保护作用。
总共228例急性冠状动脉综合征（ACS）患者被随机分为标准他汀组（SS组，n = 115）和强化他汀组（IS组，n = 113）。SS组患者在PCI前7天接受20 mg辛伐他汀，IS组患者接受80 mg辛伐他汀。在支架置入前后记录介入血管的心肌梗死溶栓（TIMI）血流分级（TFG）、校正TIMI帧数（CTFC）和TIMI心肌灌注分级（TMPG）。在手术前和手术后24小时测量肌酸激酶（CK）同工酶MB、肌钙蛋白I以及高敏C反应蛋白（hs-CRP）、P-选择素和细胞间黏附分子（ICAM）的血浆水平。
与SS组相比，IS组支架置入后的TFG显著改善，TIMI 0 - 1级血流更少，TIMI 3级血流更多（所有P < 0.05）。IS组无复流现象的患者更少（P < 0.001）。IS组的CTFC低于SS组（P < 0.001）。IS组的TMPG也比SS组有所改善（P = 0.001）。尽管PCI术后24小时CK-MB显著升高，但IS组升高的CK-MB值低于SS组（18.74±8.41 vs 21.78±10.64，P = 0.018）。肌钙蛋白I也有类似变化（IS组为0.99±1.07，SS组为1.47±1.54，P = 0.006）。SS组27.8%（32/115）的患者出现CK-MB升高，而IS组为15.9%（18/113）（P = 0.030）。SS组4.4%（5/115）的患者检测到心肌坏死，而IS组为0.9%（1/113）（P = 0.341）。但未发现心肌梗死。同样，SS组肌钙蛋白I水平升高的患者（36.5%
，42/115）比IS组（19.5%，22/113）多得多（P = 0.04）。其中，SS组13.0%（15/115）的患者检测到心肌坏死，而IS组为4.4%（5/113）（P = 0.021）。SS组4.4%（5/115）的患者发现心肌梗死，IS组为0.9%（1/113）（P = 0.213）。
PCI前7天进行强化他汀类药物预处理可进一步改善心肌血流灌注，保护心肌免受缺血损伤。这些作用与hs-CRP、P-选择素和ICAM水平降低有关。
