摘要
目的:旨在探讨阿托伐他汀对经皮冠状动脉介入(PCI)时心肌损伤的保护作用是否与内皮炎症反应的降低有关。
Objectives:The goal of this work was to investigate whether protection from myocardial injury during percutaneous coronary intervention(PCI) by atorvastatin is related to reduction of endothelial inflammatory response. Background:In the randomized ARMYDA(Atorvastatin for Reduction of MYocardial Damage during Angioplasty) trial,7-day pre-treatment with atorvastatin before PCI significantly reduced procedural myocardial injury; mechanisms underlying this effect are not characterized. Methods:In a planned subanalysis of the ARMYDA trial,a subgroup of 76 patients was blind-tested for measurement of plasma levels of vascular cell adhesion molecule-1(VCAM-1),intercellular cell adhesion molecule-1(ICAM-1),and E-selectin:38 patients belonged to atorvastatin(40 mg/day) and 38 to the placebo arm. Adhesion molecules were evaluated 7 days before intervention,immediately before PCI,and after 8 and 24 h. Results:Reduction of procedural myocardial injury after statin pre-treatment was also confirmed in this subgroup. Intercellular cell adhesion molecule-1,E-selectin,and VCAM-1 levels were not different at randomization and before intervention in either arm. At 8 h,increase of ICAM-1 levels was similar in the 2 arms,whereas 24-h levels were significantly lower in the atorvastatin versus placebo group(282±56 vs. 325±70 ng/ml; p=0.007). Attenuation of E-selectin elevation occurred at 8 h in the atorvastatin group(50±8 vs. 59±13 ng/ml; p=0.002) and became even more significant at 24 h(57±9 vs. 73±18 ng/ml; p=0.0008). Vascular cell adhesion molecule-1 levels were not different at any time point in the 2 arms. Conclusions:In patients undergoing PCI,reduction of procedural myocardial injury after 7-day pre-treatment with atorvastatin is paralleled by concomitant attenuation of post-procedural increase of ICAM-1 and E-selectin levels; thus,reduction of endothelial inflammatory response may explain this protective effect of statins.
