Cardiology Division, Prato Hospital, Prato, Italy.
Cardiology Division, Prato Hospital, Prato, Italy.
JACC Cardiovasc Interv. 2014 Dec;7(12):1421-9. doi: 10.1016/j.jcin.2014.06.023.
This study sought to investigate whether the beneficial impact of high-dose rosuvastatin against contrast-induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients varied in relation to baseline high-sensitivity C-reactive protein (hs-CRP) levels.
High-dose rosuvastatin administered on admission has been shown to prevent CI-AKI and improve short- and mid-term clinical outcome in ACS patients.
All 504 statin-naïve ACS patients enrolled in the PRATO-ACS (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Acute Kidney Injury and Myocardial Damage in ACS Patients) study were stratified into baseline hs-CRP tertiles: <2.7 mg/l, ≥2.7 to <7.5 mg/l, and ≥7.5 mg/l. The primary endpoint was CI-AKI occurrence (creatinine ≥0.5 mg/dl or ≥25% above baseline within 72 h). Logistic regression models were used to evaluate the relationship between hs-CRP levels and effects of rosuvastatin.
Patients with higher baseline hs-CRP values presented a significantly higher incidence of CI-AKI (5.4%, 8.7%, and 18.3% in the first, second, and third tertiles, respectively; p = 0.0001). The beneficial effect of rosuvastatin was markedly significant in the third hs-CRP tertile (odds ratio: 0.20; 95% confidence interval: 0.07 to 0.54; p = 0.002). Statin-treated patients in the third tertile presented a significantly lower rate of adverse events at 30 days (7.2% vs. 17.4%, p = 0.043) with a trend toward better outcome at 6 months (6.02% vs. 13.04%, p = 0.12).
High-dose rosuvastatin administered on admission appears to exert more effective kidney protection in ACS subjects with higher baseline hs-CRP levels resulting in better short- and mid-term clinical outcome. (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Nephropathy and Myocardial Damage in Patients With Acute Coronary Syndrome Undergoing Coronary Intervention [PRATO-ACS]; NCT01185938).
本研究旨在探讨在急性冠状动脉综合征（ACS）患者中，大剂量瑞舒伐他汀对造影剂诱导的急性肾损伤（CI-AKI）的有益影响是否与基线高敏 C 反应蛋白（hs-CRP）水平相关。
入院时给予大剂量瑞舒伐他汀可预防 CI-AKI，并改善 ACS 患者的短期和中期临床结局。
PRATO-ACS 研究（瑞舒伐他汀和抗血小板治疗对 ACS 患者造影剂诱导的急性肾损伤和心肌损伤的保护作用）共纳入 504 例初次使用他汀类药物的 ACS 患者，按基线 hs-CRP 三分位值分层：<2.7mg/L、≥2.7 至<7.5mg/L 和≥7.5mg/L。主要终点为 CI-AKI 发生（肌酐≥0.5mg/dl 或 72 小时内较基线升高≥25%）。采用逻辑回归模型评估 hs-CRP 水平与瑞舒伐他汀作用之间的关系。
基线 hs-CRP 值较高的患者 CI-AKI 发生率显著较高（第 1、2 和第 3 三分位值组分别为 5.4%、8.7%和 18.3%；p=0.0001）。瑞舒伐他汀在第 3 个 hs-CRP 三分位值组的有益作用显著（比值比：0.20；95%置信区间：0.07 至 0.54；p=0.002）。第 3 个 hs-CRP 三分位值组的他汀类药物治疗患者在 30 天时的不良事件发生率显著较低（7.2%比 17.4%，p=0.043），6 个月时的结局较好（6.02%比 13.04%，p=0.12）。
入院时给予大剂量瑞舒伐他汀似乎在基线 hs-CRP 水平较高的 ACS 患者中具有更有效的肾脏保护作用，从而改善短期和中期临床结局。（瑞舒伐他汀和抗血小板治疗对接受冠状动脉介入治疗的急性冠状动脉综合征患者造影剂肾病和心肌损伤的保护作用[PRATO-ACS]；NCT01185938）。
