强化他汀类药物治疗对老年非ST段抬高型急性冠脉综合征患者经皮冠状动脉介入术中的心肌保护作用

High dose statin pretreatment for myocardial protection during percutaneous coronary intervention in elderly patients with non-ST-segment-elevation acute coronary syndrome

摘要:

目的探讨经皮冠状动脉介入(PCI)术前短期的高剂量阿托伐他汀的强化预处理对老年非ST段抬高型急性冠脉综合征(NSTEACS)患者PCI术中的心肌保护作用。方法92例住院准备PCI治疗的老年ACS患者随机分为强化组(PCI术前使用阿托伐他汀40mg/d预处理3～5d,共47例)和对照组(PCI术前仅使用阿托伐他汀10mg/d预处理3～5d,共45例),其余药物治疗两组类似,后行PCI治疗,术前均再次服用300mg负荷剂量的氯吡格雷。主要观察指标为术后8、24h的肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平的变化和术后24h的肌钙蛋白(cTnI)超过正常上限的比例、30d的主要心脏不良事件(MACE,死亡、再发心肌梗死、再次血运重建)。结果PCI术后24h的CK、CK-MB水平,对照组显著高于强化组〔(4.1±0.4),(0.38±0.12)g/Lvs(3.2±0.5),(0.31±0.09)g/L;P<0.05〕;而术后8h的CK、CK-MB水平两组无显著性差异;术后24h的cTnI超过正常上限的比例及CK、CK-MB水平超过正常上限3倍的比率,差异有统计学意义(8.5%、6.4%、6.4%vs26.7%、15.6%、17.8%;P<0.05);术后30d强化组的MACE发生率12.8%,低于对照组17.8%,但无显著性差异。结论对于行PCI治疗的老年ACS患者,高剂量的阿托伐他汀短期预处理可以减轻PCI术中的心肌损伤。

Abstract:

Objective To investigate the myocardial protection effect of short-term high dose statin pretreatment during percutaneous coronany intervention (PCI) in elderly patients with non-ST-segment-elevation acute coronary syndrome (NSTEACS). Methods Ninety-two elderly NSTEACS patients admitted for PCI were randomized into high dose atorvastatin group (atorvastatin 40 mg/d,n=47) and control group (atorvastatin 10 mg/d,n=45). A 3 to 5-day pretreatment with atorvaststin was given to the subjects. The two groups were identical in other medication treatment. Before PCI,all subjects received oral administration of clopidogrel 300mg as a dose again.Levels of creatine kinase (CK),CK-MB and cTnI level were measured at baseline,8 and 24 h after the procedure. Major adverse cardiac events (MACE,including death,myocardial infarction and revascularization) at 30-day follow-up visit were analyzed. Results The levels of CK and CK-MB at 24 h were significantly lower in high dose atorvastatin group than in control group〔(3.2±0.5) vs (4.1±0.4) g/L,(0.31±0.09) vs (0.38±0.12) g/L,P<0.05〕,while they were not significantly different at 8 h between two groups. The proportion of patients with cTnI level above normal up-limit value and that with CK,CK-MB level above 3-fold normal up-limit at 24-hour was significantly lower in high dose atorvastatin group than in control group ( 8.5% vs 26.7%,6.4% vs 15.6%,6.4% vs 17.8%,P<0.05). MACE incidence at 30-day follow-up visit was lower in high dose atorvastatin group (12.8%) than in control group (17.8%),but with no significant difference. Conclusion High dose atorvastatin pretreatment provides myocardial protection during PCI in elderly patients with NSTEACS.?更多