Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Curr Opin Cardiol. 2010 Jul;25(4):373-8. doi: 10.1097/HCO.0b013e32833987ca.
This review discusses the role of statin therapy in patients with acute coronary syndromes. These drugs modulate endothelial function and stabilize atherosclerotic plaque by inhibiting oxidative stress and inflammation and may provide a relevant clinical benefit in unstable patients.
Conflicting data derive from randomized trials about early statin therapy in medically treated patients with acute coronary syndromes. Results of the ARMYDA studies demonstrate a clear benefit of statin pretreatment in patients with both stable and unstable syndromes undergoing percutaneous coronary revascularization. In the ARMYDA RECAPTURE, even an acute reload with high-dose atorvastatin in patients on top of chronic statin use was associated with a significant reduction of 30-day major adverse cardiac events, especially in those patients who presented with acute coronary syndromes.
All this evidence strongly supports an 'upstream' administration of high-dose statins in patients with acute coronary syndromes treated with an early invasive strategy.
本文讨论了他汀类药物治疗急性冠脉综合征（ACS）患者的作用。这些药物通过抑制氧化应激和炎症来调节内皮功能和稳定动脉粥样硬化斑块，可能为不稳定型患者提供相关的临床获益。
来自随机试验的关于 ACS 患者药物治疗中早期他汀类药物治疗的数据存在冲突。ARMYDA 研究的结果表明，他汀类药物预处理在接受经皮冠状动脉血运重建治疗的稳定型和不稳定型综合征患者中均具有明确获益。在 ARMYDA RECAPTURE 研究中，即使在慢性他汀类药物治疗的基础上加用大剂量阿托伐他汀进行急性再负荷治疗，也可显著降低 30 天主要不良心脏事件，尤其是在那些患有急性冠脉综合征的患者中。
所有这些证据均强烈支持在早期采用有创策略治疗 ACS 的患者中给予大剂量他汀类药物的“上游”治疗。
