单次高负荷量阿托伐他汀对PCI围手术期心肌标志物及心肌梗死的影响

Effects of single high loading dose of atorvastatin on periprocedural cardiac markers and myocardial infarction

目的:观察经皮冠状动脉介入(PCI)治疗前服用80mg阿托伐他汀能否降低围手术期心肌标志物水平及心肌梗死的发生率。方法:173例择期PCI冠心病患者随机分为两组:阿托伐他汀组予冠心病基础药物治疗,并在PCI前12h给予单次高负荷剂量(80mg)阿托伐他汀;对照组仅予基础药物治疗。PCI后18h测肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB)。结果:术后阿托伐他汀组CK-MB和TnI水平显著低于对照组[分别为(2.76±4.63)ng/ml对(10.53±24.39)ng/ml,P<0.01和(0.14±0.19)ng/ml对(1.31±4.31)ng/ml,P<0.05];阿托伐他汀组术后CK-MB和TnI升高大于正常上限3倍者显著少于对照组(分别为2.3%对16.3%,P<0.01和24.1%对48.8%,P<0.01)。结论:对于稳定型心绞痛及心肌标志物水平正常的不稳定型心绞痛患者,介入术前给予单次80mg阿托伐他汀能显著降低围术期心肌标志物水平以及由此反映的围术期心肌梗死的发生率。

Objective：To investigate whether loading 80mg atorvastatin prior to percutaneous coronary intervention （PCI） can efficiently reduce the incidence of periprocedural myocardial infarction and the reading of cardiac markers. Methods：A total of 173 patients with coronary artery disease who underwent selective PCI were enrolled in this study and randomized into two groups： the atorvastatin group and the control group. The atorvastatin group was given a single loading of 80mg atorvastatin 12 hours before receiving PCI on top of routine medical therapy. The control group was treated with routine medication alone. TnI and CK-MB were checked for all patients 18 hours after PCI. Results：Post-operative CK-MB and TnI levels in atorvastatin group were significantly lower than those in control group （2.76 （4.63 ng/mlvs. 10.53（24.39ng/ml,P〈0.01;0.14（0.19ng/mlvs. 1.31（4.31ng/ml,P〈0.05; respectively）. Moreover,the number of patients with CK-MB and TnI level 3 times above the normal value in atorvastatin group was significantly less than that in control group （2.3% vs. 16.3% ,P〈0.01 ;24. 1% vs. 48.8% ,P〈0.01; respectively）. Conclusion：The level of cardiac markers and corresponding incidence of myocardial infarction could be reduced by a single high loading dose of 80mg atorvastatin given prior to PCI in stable angina patients and unstable angina patients with normal cardiac markers.