急性心肌梗死介入治疗术前早期应用大剂量瑞舒伐他汀对冠状动脉微血管功能及近期预后的意义

Effects of early administration of high-dose rosuvastatin on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary intervention for acute myocardial infarction

目的分析经皮冠状动脉介入治疗（PCI）术前早期给予大剂量瑞舒伐他汀对急性心肌梗死（AMI）患者冠状动脉微血管功能以及近期预后的影响。方法2010年1月至2014年1月收治的行PCI的94例AMI患者，按随机数字表法分为对照组（4J4例）及观察组（50例）；对照组术后给予10mg／d的瑞舒伐他汀，观察组在PCI术前早期给予40mg的瑞舒伐他汀，术后同对照组。心肌及微血管的灌注情况采用TIMI心肌灌注分级（TMPG）进行评价，同时观察随访30d内的主要心血管事件（MACE）的发生情况。结果与术前比较，观察组和对照组术后TMPG分级[（2．7±0．2）级比（1．5±0．5）级、（2．0±0．8）级比（1．4±0．9）级]比较均差异有统计学意义（P〈0．05），但观察组TMPG比对照组改善的更加显著（P〈0．05）。观察组随访30d内MACE的发生率为12．0％（6／50），明显低于对照组的34．1％（15／44），差异有统计学意义（P〈0．05）；观察组术后TMPG3级患者MACE的发生率（11．1％，3，27）低于对照组（6／14），差异有统计学意义（P〈0．05）。两组经随访均未见肌毒性及肝毒性等不良反应发生。结论PCI术前早期给予大剂量的瑞舒伐他汀（40mg）对改善AMI患者的冠状动脉微血管功能及近期预后是有益处的。

Objective To investigate effects of early administration of high-dose rosuvastatin（40 mg） on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary intervention （PCI） for acute myocardial infarction（AMI）. Methods Ninety-four consequent AMI patients treated with primary PCI were divided into rosuvastatin group （50 patients） and control group （44 group）. The infarct-related artery flow of epicardium was classified in compliance with the TIMI criteria. Myocardial and microvascular perfusion was assessed using the TMPG. The incidence of the MACE and the cytotoxicity and hepatotoxicity of rosuvastatin was respectively recorded in 30 d follow-up period. Results Either patients in the rosuvastatin group or in the control group showed better TMPG immediately after PCI （P 〈 0.05）, compared with that before treatment. However, the post-PCI TMPG of the rosuvastatin group was obviously much better than that of control group （P 〈 0.05）. Compared with that in control group, the 30 - day composite MACE rate was lower in rosuvastatin group and in the TMPG 3 patients of rosuvastatin group： 12.0 % （6/50） vs. 34.1% （15/44）, P 〈 0.05; 11.1% （3/27） vs. 42.9% （6/14）. There was no cytotoxicity and hepatotoxicity in two groups. Conclusions Early administration of high-dose rosuvastatin （40 mg） can improve coronary microvascular function and shortterm outcome in patients treated with primary PCI for AMI, and it is efficient and safety.