División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Arch Med Res. 2018 Nov;49(8):620-629. doi: 10.1016/j.arcmed.2018.10.006. Epub 2018 Nov 13.
No reflow defined as an altered myocardial reperfusion and failure at microvascular level is a frequent complication in acute myocardial infarction that attenuates beneficial effect of reperfusion therapy leading to poor outcomes. There is not enough evidence to support that previous use of statins improves coronary flow in patients undergoing primary percutaneous coronary intervention (PCI).
To determine if a loading dose of 80 mg of atorvastatin before primary angioplasty reduces the frequency of no reflow, hs-CRP, IL6 intracoronary levels, and major combined cardiovascular events at 30 d.
In this controlled clinical trial, we randomly assigned 103 adult patients within the 12 h of acute ST-elevation myocardial infarction (STEMI) to receive 80 mg of atorvastatin additional to standard treatment (AST) before performing primary PCI versus standard treatment (ST) alone. The primary outcomes were the occurrence of no reflow and high sensitivity C-reactive protein (hs-CRP) and interleukin 6 levels and secondary outcomes were major adverse cardiovascular events at 30 d.
103 patients were analyzed, 49 (48%) received AST, 54 (52%) ST. Frequency of no reflow among groups was 27 vs. 63% respectively, p ≤0.0001. hs-CRP level was 2.69 mg/dL for AST vs. 2.2 mg/dL in ST, meanwhile IL-6 levels were 5.2 pg/mL vs. 6.35 pg/mL respectively, p = ns. Cox regression model demonstrated that the treatment assigned is an independent predictor for no reflow occurrence (HR 0.34 95%, CI 0.18-0.61, p ≤0.001).
The administration of a loading dose of 80 mg atorvastatin before primary PCI is an effective strategy for prevention of no reflow improving also clinical outcomes and free survival rate for the presentation of major adverse cardiovascular events at 30 d.
无复流定义为微血管水平的心肌再灌注和功能障碍，是急性心肌梗死的常见并发症，削弱了再灌注治疗的有益效果，导致预后不良。没有足够的证据支持在接受直接经皮冠状动脉介入治疗（PCI）的患者中，之前使用他汀类药物可改善冠状动脉血流。
确定在直接血管成形术前给予 80mg阿托伐他汀负荷剂量是否可以降低无复流、高敏 C 反应蛋白（hs-CRP）、白细胞介素 6 （IL-6）的冠状动脉内水平的发生率，并降低 30 天时主要心血管复合事件的发生率。
在这项对照临床试验中，我们将 103 例急性 ST 段抬高型心肌梗死（STEMI）后 12 小时内的成年患者随机分为两组，分别在直接 PCI 术前加用 80mg 阿托伐他汀（AST 组）和仅接受标准治疗（ST 组）。主要结局是无复流的发生以及高敏 C 反应蛋白（hs-CRP）和白细胞介素 6 （IL-6）水平，次要结局是 30 天时的主要不良心血管事件。
分析了 103 例患者，其中 49 例（48%）接受 AST 治疗，54 例（52%）接受 ST 治疗。两组无复流的发生率分别为 27%和 63%，p ≤0.0001。AST 组的 hs-CRP 水平为 2.69mg/dL，ST 组为 2.2mg/dL，而 IL-6 水平分别为 5.2pg/mL 和 6.35pg/mL，p 值无统计学意义。Cox 回归模型表明，治疗方法是无复流发生的独立预测因素（HR 0.34，95%可信区间 0.18-0.61，p ≤0.001）。
在直接 PCI 术前给予 80mg 阿托伐他汀负荷剂量是一种有效的预防无复流的策略，还可以改善临床结局和 30 天时主要不良心血管事件的无事件生存率。
