Chitose Tadasuke, Sugiyama Seigo, Sakamoto Kenji, Shimomura Hideki, Yamashita Takuro, Hokamaki Jun, Tsunoda Ryusuke, Shiraishi Shinya, Yamashita Yasuyuki, Ogawa Hisao
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Japan; Social Insurance Omuta-Tenryo Hospital, 1-100 Tenryo, Omuta City Fukuoka 836-8566, Japan.
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Japan; Division of Cardiovascular Medicine, Diabetes Care Center, Jinnouchi Hospital, 6-2-3 Kuhonji, Chuo-ku, Kumamoto City 862-0976, Japan.
Atherosclerosis. 2014 Nov;237(1):251-8. doi: 10.1016/j.atherosclerosis.2014.08.053. Epub 2014 Sep 16.
Early statin therapy after acute coronary syndrome reduces atherothrombotic vascular events. This study aimed to compare the effects of hydrophilic and hydrophobic statins on myocardial salvage and left ventricular (LV) function in patients with ST-elevated myocardial infarction (STEMI).
Seventy-five STEMI patients who had received emergency reperfusion therapy were enrolled and randomized into the hydrophilic statin group (rosuvastatin; 5 mg/day, n = 38) and hydrophobic statin group (atorvastatin; 10 mg/day, n = 37) for 6 months. LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) and co-enzyme Q10 (CoQ10) levels were measured at baseline and the end of treatment. The myocardial salvage index was assessed by single photon emission computed tomography with (123-)I-β-methyl-iodophenylpentadecanoic acid (ischemic area-at-risk at onset of STEMI: AAR) and (201-)thallium scintigraphy (area-at-infarction at 6 months: AAI) [myocardial salvage index = (AAR-AAI) × 100/AAR (%)].
Onset-to-balloon time and maximum creatine phosphokinase levels were comparable between the groups. After 6 months, rosuvastatin (-37.6% ± 17.2%) and atorvastatin (-32.4% ± 22.4%) equally reduced low-density lipoprotein-cholesterol (LDL-C) levels (p = 0.28). However, rosuvastatin (+3.1% ± 5.9%, p < 0.05), but not atorvastatin (+1.6% ± 5.7%, p = 0.15), improved LVEF. Rosuvastatin reduced BNP levels compared with atorvastatin (-53.3% ± 48.8% versus -13.8% ± 82.9%, p < 0.05). The myocardial salvage index was significantly higher in the rosuvastatin group than the atorvastatin group (78.6% ± 29.1% versus 52.5% ± 38.0%, p < 0.05). CoQ10/LDL-C levels at 6 months were increased in the rosuvastatin group (+23.5%, p < 0.01) and percent changes in CoQ10/LDL-C were correlated with the myocardial salvage index (r = 0.56, p < 0.01).
Rosuvastatin shows better beneficial effects on myocardial salvage than atorvastatin in STEMI patients, including long-term cardiac function, associated with increasing CoQ10/LDL-C.
URL http://www.umin.ac.jp/ctr/index.htm Unique Identifier: UMIN000003893.
急性冠状动脉综合征后早期使用他汀类药物治疗可减少动脉粥样硬化血栓形成性血管事件。本研究旨在比较亲水性和疏水性他汀类药物对ST段抬高型心肌梗死（STEMI）患者心肌挽救和左心室（LV）功能的影响。
纳入75例接受急诊再灌注治疗的STEMI患者，随机分为亲水性他汀组（瑞舒伐他汀；5mg/天，n = 38）和疏水性他汀组（阿托伐他汀；10mg/天，n = 37），治疗6个月。在基线和治疗结束时测量左心室射血分数（LVEF）、B型利钠肽（BNP）和辅酶Q10（CoQ10）水平。采用单光子发射计算机断层扫描，使用（123-）I-β-甲基碘代苯十五烷酸（STEMI发作时的缺血危险区：AAR）和（201-）铊闪烁显像（6个月时的梗死区：AAI）评估心肌挽救指数[心肌挽救指数=（AAR - AAI）×100/AAR（%）]。
两组患者的球囊扩张时间和最高肌酸磷酸激酶水平相当。6个月后，瑞舒伐他汀（-37.6%±17.2%）和阿托伐他汀（-32.4%±22.4%）降低低密度脂蛋白胆固醇（LDL-C）水平的效果相当（p = 0.28）。然而，瑞舒伐他汀（+3.1%±5.9%，p < 0.05）可改善LVEF，而阿托伐他汀（+1.6%±5.7%，p = 0.15）则不能。与阿托伐他汀相比，瑞舒伐他汀降低了BNP水平（-53.3%±48.8%对-13.8%±82.9%，p < 0.05）。瑞舒伐他汀组的心肌挽救指数显著高于阿托伐他汀组（78.6%±29.1%对52.5%±38.0%，p < 0.05）。瑞舒伐他汀组6个月时的CoQ10/LDL-C水平升高（+23.5%，p < 0.01），CoQ10/LDL-C的百分比变化与心肌挽救指数相关（r = 0.56，p < 0.01）。
在STEMI患者中，瑞舒伐他汀在心肌挽救方面比阿托伐他汀显示出更好的有益效果，包括长期心脏功能，这与CoQ10/LDL-C升高有关。
网址http://www.umin.ac.jp/ctr/index.htm 唯一标识符：UMIN000003893
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