大剂量瑞舒伐他汀与阿托伐他汀预防急性心肌梗死患者胱抑素C导向的造影剂肾病的疗效比较：RACCOON-AMI注册研究
Comparative Efficacy of High-Dose Rosuvastatin and Atorvastatin in Preventing Cystatin C-Oriented Contrast-Induced Nephropathy in Patients With Acute Myocardial Infarction: RACCOON-AMI Registry.
作者信息
Kim Ji Hye, Kim Hyunah, Choi Seung-Hyuk, Chun Woo Jeong, Doh Joon Hyung, Lee Jong-Young, Lee Seung-Jae, Kim Byung Jin
机构信息
Division of Nephrology, Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea.
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2025 Apr 14;40(14):e50. doi: 10.3346/jkms.2025.40.e50.
BACKGROUND
Prevention of contrast-induced nephropathy (CIN) is crucial in acute myocardial infarction (AMI) patients undergoing coronary interventions. Previous studies suggest that high-dose statins may aid in CIN prevention, yet comparative studies among different statin types using cystatin C (cysC) as a biomarker for CIN are absent. This study evaluated the effectiveness of high-dose rosuvastatin versus atorvastatin in preventing cysC-based CIN (cysC-CIN) in AMI patients.
METHODS
This multicenter registry included 431 patients (rosuvastatin 20 mg: n = 231, atorvastatin 40 mg: n = 200). The primary endpoint was cysC-CIN incidence within 48 hours post contrast; the secondary endpoints were creatinine-based CIN (cr-CIN) incidence within 72 hours post contrast and post 30 days adverse events.
RESULTS
The incidences of cysC-CIN (12.1% vs. 7.5%, = 0.103) and cr-CIN (6.2% vs. 3.5%, = 0.103) were higher in the atorvastatin group without significant statistical differences. Multivariable regression analysis, which was adjusted for CIN risk factors and the variables with univariate association, showed no increased odds ratio (OR) (OR, 2.185; 95% confidence interval [CI], 0.899, 5.315; = 0.085) for cysC-CIN in the atorvastatin group compared to the rosuvastatin group. However, statin-naïve atorvastatin subgroup had significantly increased odds of cysC-CIN compared to the rosuvastatin group (OR, 2.977; 95% CI, 1.057, 8.378; = 0.039). At post 30 days renal, cardiovascular, and mortality event rates were both low and similar between the two groups.
CONCLUSION
No significant difference in cysC-CIN incidence was found between the high-dose rosuvastatin and atorvastatin groups in AMI patients and cysC was more sensitive to the early detection of CIN than creatinine.
TRIAL REGISTRATION
Clinical Research Information Service Identifier: KCT0003703.
背景
预防造影剂肾病（CIN）在接受冠状动脉介入治疗的急性心肌梗死（AMI）患者中至关重要。既往研究表明，大剂量他汀类药物可能有助于预防CIN，但缺乏以胱抑素C（cysC）作为CIN生物标志物的不同他汀类药物之间的比较研究。本研究评估了大剂量瑞舒伐他汀与阿托伐他汀在预防AMI患者基于cysC的CIN（cysC-CIN）方面的有效性。
方法
这项多中心注册研究纳入了431例患者（瑞舒伐他汀20mg：n = 231，阿托伐他汀40mg：n = 200）。主要终点是造影后48小时内cysC-CIN的发生率；次要终点是造影后72小时内基于肌酐的CIN（cr-CIN）发生率以及30天后的不良事件。
结果
阿托伐他汀组的cysC-CIN（12.1%对7.5%，P = 0.103）和cr-CIN（6.2%对3.5%，P = 0.103）发生率较高，但无显著统计学差异。在对CIN危险因素和单变量关联变量进行校正的多变量回归分析中，与瑞舒伐他汀组相比，阿托伐他汀组cysC-CIN的优势比（OR）未增加（OR，2.185；95%置信区间[CI]，0.899，5.315；P = 0.085）。然而，与瑞舒伐他汀组相比，初治阿托伐他汀亚组的cysC-CIN优势比显著增加（OR，2.977；95%CI，1.057，8.378；P = 0.039）。在30天后，两组的肾脏、心血管和死亡率事件发生率均较低且相似。
结论
在AMI患者中，大剂量瑞舒伐他汀组和阿托伐他汀组的cysC-CIN发生率无显著差异，且cysC对CIN的早期检测比肌酐更敏感。
试验注册
临床研究信息服务标识符：KCT0003703。
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