Division of Nephrology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).
Division of Cardiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).
Med Sci Monit. 2018 Dec 17;24:9166-9176. doi: 10.12659/MSM.911921.
BACKGROUND For coronary artery disease, percutaneous coronary intervention (PCI) is the preferred treatment. Reperfusion injury is a common and serious complication of PCI. Studies showed that early statin therapy has a favorable prognostic impact for patients undergoing PCI. However, the effects of statins on improving post-PCI myocardial perfusion are still unclear. In this study we evaluated the potential effect of high-dose statin pretreatment on postprocedure myocardial perfusion and MACE rate in patients receiving PCI. MATERIAL AND METHODS We searched randomized controlled trials that evaluated the effect of high-dose statin pretreatment on post-PCI TIMI flow grade and MACE in patients undergoing PCI from the databases of PubMed, Embase, and Cochrane Library. All data were pooled for analysis and were stratified by type of statin, clinical presentation, and current statin therapy status in subgroup. RESULTS Fifteen RCTs with 4240 individuals were selected. The pooled analysis showed that high-dose statin pretreatment before PCI significantly improved the final TIMI flow grade compared with the control group (OR=0.61, 95% CI: 0.46 to 0.80, p=0.0005), and showed reduced incidence of MACE (OR=0.53, 95%CI: 0.39 to 0.71, p<0.0001). In subgroup analysis, the beneficial effect of high-dose statin was significant in statin-naive treatment patients, ACS patients, and patients on atorvastatin therapy, but no difference occurred in rosuvastatin, previous statin therapy, and stable angina patients. CONCLUSIONS High-dose statin pretreatment has an important effect on postprocedure myocardial perfusion by improving the TIMI flow in patients undergoing PCI, and high-dose statin preloading also reduces the incidence of MACE.
对于冠状动脉疾病，经皮冠状动脉介入治疗（PCI）是首选的治疗方法。再灌注损伤是 PCI 的常见且严重的并发症。研究表明，早期他汀类药物治疗对接受 PCI 的患者具有有利的预后影响。然而，他汀类药物对改善 PCI 后心肌灌注的影响仍不清楚。在这项研究中，我们评估了高剂量他汀预处理对接受 PCI 的患者术后心肌灌注和主要不良心脏事件（MACE）发生率的潜在影响。
我们从 PubMed、Embase 和 Cochrane Library 数据库中搜索了评估高剂量他汀预处理对接受 PCI 的患者术后 TIMI 血流分级和 MACE 的影响的随机对照试验。对所有数据进行汇总分析，并按他汀类型、临床表现和当前他汀治疗状况进行亚组分层。
纳入了 15 项 RCT 共 4240 例患者。汇总分析显示，PCI 前高剂量他汀预处理与对照组相比，显著改善了最终 TIMI 血流分级（OR=0.61，95%CI：0.46 至 0.80，p=0.0005），并降低了 MACE 的发生率（OR=0.53，95%CI：0.39 至 0.71，p<0.0001）。亚组分析显示，在他汀类药物初治治疗患者、ACS 患者和接受阿托伐他汀治疗的患者中，高剂量他汀的有益作用显著，但在 rosuvastatin、既往他汀治疗和稳定性心绞痛患者中则无差异。
高剂量他汀预处理通过改善接受 PCI 的患者的 TIMI 血流，对术后心肌灌注有重要影响，高剂量他汀预处理还降低了 MACE 的发生率。
