Lee Bong-Ki, Koo Bon-Kwon, Nam Chang-Wook, Doh Joon-Hyung, Chung Woo-Young, Cho Byung-Ryul, Fearon William F
Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea.
Division of Cardiology, Seoul National University Hospital, Seoul, Korea.
Korean Circ J. 2016 Jul;46(4):472-80. doi: 10.4070/kcj.2016.46.4.472. Epub 2016 Jul 21.
There is controversy surrounding whether or not high dose statin administration before percutaneous coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing PCI.
Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration 12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinase-myocardial band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI.
The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40 ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to 0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001).
Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an immediate anti-inflammatory effect in patients with NSTE-ACS.
经皮冠状动脉介入治疗（PCI）前给予高剂量他汀类药物是否会减少围手术期微血管损伤，目前存在争议。我们进行了一项前瞻性随机研究，以探讨PCI术前给予高剂量阿托伐他汀对非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者心肌损伤的机制及影响。
77例NSTE-ACS患者被随机分为高剂量组（PCI术前12至24小时给予阿托伐他汀80mg负荷剂量，PCI术前2小时再给予40mg负荷剂量，n = 39）或低剂量组（PCI术前12至24小时给予阿托伐他汀10mg，n = 38）。支架植入后测量微血管阻力指数（IMR）。在PCI术前和术后测量肌酸激酶同工酶（CK-MB）和高敏C反应蛋白（CRP）水平。
两组患者的基线特征无差异。与低剂量组相比，高剂量组PCI术后IMR较低（14.1±5.0 vs. 19.2±9.3 U，p = 0.003）。高剂量组PCI术后CK-MB也较低（中位数：1.40 ng/mL（四分位间距[IQR：0.75至3.45]） vs. 4.00 [IQR：1.70至7.37]，p = 0.002），PCI术后CRP水平也较低（0.09 mg/dL [IQR：0.04至0.16] vs. 0.22 [IQR：0.08至0.60]，p = 0.001）。
高剂量阿托伐他汀预处理可降低PCI术后IMR所证实的围PCI期微血管功能障碍，并对NSTE-ACS患者产生即时抗炎作用。
