术前强化他汀治疗对高龄冠心病患者冠脉介入治疗预后的影响

Effect of intensive pretreatment with atorvastatin calcium on outcomes of percutaneous coronary intervention in elderly patients with coronary heart disease

目的观察术前应用不同负荷剂量阿托伐他汀钙对高龄冠心病患者经皮冠状动脉介入治疗（PCI）预后的影响。方法将120例≥80岁的择期PCI冠心病患者随机分为20 mg他汀组（40例）、40 mg他汀组（40例）和60 mg他汀组（40例）,在入院后48~72 h内接受PCI。分别于PCI术前使用阿托伐他汀钙20、40、60 mg/d,观察3组患者术后心脏生化标志物肌酸激酶同工酶（CKMB）、肌钙蛋白I（c TNI）及高敏C反应蛋白（hs CRP）等指标变化及术后1个月内主要不良心脏事件（MACE,包括心源性死亡、心肌梗死和靶血管血运重建）的发生率。结果最终20 mg他汀组有34例患者、40 mg他汀组有40例患者、60 mg他汀组有38例患者完成本课题研究,20、40、60 mg他汀组PCI术后12 h、术后24 h hs-CRP与术前对比显著升高（P〈0.05）,60 mg他汀组术后24 h CKMB、c TNI、hs-CRP显著低于20 mg他汀组（P〈0.05）。60 mg他汀组PCI术后30 d内总MACE事件显著低于20 mg他汀组（2.6%比26.5%,P=0.003）,主要原因是60 mg他汀组与PCI相关的心肌梗死显著低于20 mg他汀组（2.6%比20.6%,P=0.016）。三组药物不良反应无统计学差异（P〉0.05）。结论高龄冠心病患者择期PCI术前强化阿托伐他汀钙60 mg/d可以显著减少与PCI相关的心肌梗死,并且安全性良好。

Objective To observe the effects of different loading doses of atorvastatin calcium on the outcomes of percutaneous coronary intervention（PCI） in elderly patients with coronary heart disease（CHD）. Methods A total of 120 CHD patients aged over 80 years were randomly assigned into 3 equal groups to receive intensive pretreatment with statin at the doses of 20, 40,or 60 mg prior to PCI performed within 48 to 72 h after admission. The changes of postoperative cardiac biochemical markers including creatine kinase isoenzyme（CKMB）, troponin I（c TNI） and high-sensitivity c-reactive protein（hs-CRP） were observed and the incidence of major adverse cardiac events（MACE, including cardiac death, myocardial infarction, and target vessel revascularization） were recorded within 30 days after PCI. Results Thirty- four patients in 20 mg statin group, 40 in 40 mg statin group, and 38 in 60 mg statin group completed this study. In all the 3 groups, hs-CRP level significantly increased at 12 and 24 h after PCI compared with the preoperative levels（P〈0.05）. The patients in 60 mg statin group showed significantly lower levels of CKMB, c TNI, and hs- CRP at 24 h after PCI than those in 20 mg statin group（P〈0.05）, and had also a significantly lower incidence of total MACE within 30 days after PCI（2.6% vs 26.5%, P=0.003） resulting primarily from significantly reduced myocardial infarction associated with PCI（2.6% vs 20.6%, P=0.016）. The adverse drug reactions were comparable among the 3 groups（P〉0.05）. Conclusions Intensive pretreatment with 60 mg/day atorvastatin calcium can significantly reduce myocardial infarction related to PCI with good safety in elderly patients with CHD.