Abaci Okay, Arat Ozkan Alev, Kocas Cuneyt, Cetinkal Gokhan, Sukru Karaca Osman, Baydar Onur, Kaya Aysem, Gurmen Tevfik
Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey.
Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey.
Am J Cardiol. 2015 Apr 1;115(7):867-71. doi: 10.1016/j.amjcard.2015.01.007. Epub 2015 Jan 14.
Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) who underwent elective coronary or peripheral angiography were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; n = 110) or no statin treatment (control group, n = 110). Contrast-induced acute kidney injury was defined by an absolute increase in serum creatinine of ≥0.5 mg/dl or a relative increase of ≥25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p = 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography.
尽管他汀类药物已被证明可预防急性冠状动脉综合征患者发生造影剂诱导的急性肾损伤，但对于接受选择性冠状动脉造影的肾病高危患者，他汀类药物的益处尚不清楚。连续220例未服用过他汀类药物的慢性肾脏病患者（估计肾小球滤过率<60 ml/min/1.73 m²）接受选择性冠状动脉或外周血管造影，被随机分配接受瑞舒伐他汀治疗（入院时40 mg，随后20 mg/天；n = 110）或不接受他汀类药物治疗（对照组，n = 110）。造影剂诱导的急性肾损伤定义为术后48或72小时血清肌酐绝对值增加≥0.5 mg/dl或相对增加≥25%。15例患者（7.2%）发生了造影剂诱导的急性肾损伤，对照组9例（8.5%），瑞舒伐他汀组6例（5.8%）（p = 0.44）。随访时两组不良心血管和肾脏事件（死亡、透析、心肌梗死、中风或持续性肾损害）的发生率相似。总之，瑞舒伐他汀并未降低接受冠状动脉和外周血管造影的高危患者发生造影剂诱导的急性肾损伤或其他临床相关结局的风险。
