Use of statins prior to percutaneous coronary intervention reduces myonecrosis and improves clinical outcome
Use of statins prior to percutaneous coronary intervention reduces myonecrosis and improves clinical outcome
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DOI：
10.1002/ccd.20078
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发表时间：
2004-06-01
影响因子：
2.3
通讯作者：
Lakkis, NM
中科院分区：
文献类型：
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作者：
Chang, SM;Yazbek, N;Lakkis, NM
他汀类药物的一级和二级预防可减少冠状动脉疾病患者的主要心脏事件。经皮冠状动脉介入治疗 (PCI) 之前使用他汀类药物进行预处理的影响尚未明确。本研究的目的是确定 PCI 前使用他汀类药物进行预处理是否可以减少肌坏死并改善临床结果。确定了连续 119 名接受 PCI 的急性冠状动脉综合征患者。我们比较了 PCI 前接受他汀类药物治疗的患者 (n = 63) 和未接受 PCI 治疗的患者 (n = 56) 的肌坏死发生率（定义为 24 小时内 CK-MB 或 CK 峰值升高至正常上限三倍以上）以及 6 个月心血管事件发生率（死亡、与 PCI 无关的非致命性心肌梗死、靶血管血运重建和需要住院治疗的不稳定心绞痛）。接受过治疗的患者更有可能有心肌梗死或血运重建病史（63% vs. 43%；P = 0.015）、高脂血症（80% vs. 48%；P = 0.001）、高血压（83% vs. 49%；P = 0.02）以及使用血管紧张素转换酶抑制剂（62% vs. 38%；P = 0.02）。 0.008）。两组之间的其余基线特征相似，包括糖蛋白 IIb/IIIa 抑制剂的使用、病变血管的数量和病变类型。接受他汀类药物预处理的患者在 24 小时时的肌坏死发生率显着较低（2% vs. 10%；P = 0.04），并且在 6 个月时的临床事件 (CE) 率显着较低（17% vs. 21%；P = 0.015）。在未接受他汀类药物治疗的患者中，72% 的患者在 6 个月时服用他汀类药物，而接受过他汀类药物治疗的患者中这一比例为 98%。调整所有基线特征后，PCI 前使用他汀类药物与所有 CE 风险显着降低相关（OR = 0.2；CI = 0.06-0.63；P = 0.006）。 PCI 前的他汀类药物治疗可减少 PCI 周围肌坏死和晚期心脏事件。这些结果需要在大型前瞻性随机试验中得到证实。 (C) 2004 Wiley-Liss, Inc.
Primary and secondary prevention with statins reduce major cardiac events in patients with coronary artery disease. The impact of pretreatment with statins prior to percutaneous coronary intervention (PCI) is not well established. The objective of this study was to determine if pretreatment with statins prior to PCI reduce myonecrosis and improve clinical outcome. One hundred nineteen consecutive patients with acute coronary syndrome who underwent PCI were identified. We compared the incidence of myonecrosis defined as peak elevation of CK-MB or CK three time above upper limit of normal within 24 hr and the 6-month cardiovascular event rate (death, nonfatal myocardial infarction unrelated to PCI, target vessels revascularization, and unstable angina requiring hospitalization) among patients who received statins prior to PCI (n = 63) to those who did not (n = 56). Pretreated patients were more likely to have history of myocardial infarction or revascularization (63% vs. 43%; P = 0.015), hyperlipidemia (80% vs. 48%; P = 0.001), hypertension (83% vs. 49%; P = 0.02), and use of angiotensin-converting enzyme inhibitor (62% vs. 38%; P = 0.008). The rest of baseline characteristics were similar between the two groups, including use of glycoprotein IIb/IIIa inhibitors, number of diseased vessels, and type of lesions. Patients pretreated with statins had a significantly lower incidence of myonecrosis (2% vs. 10%; P = 0.04) at 24 hr and a significantly lower clinical event (CE) rate at 6 months (17% vs. 21%; P = 0.015). Of patients not pretreated with statins, 72% were taking statins at 6 months as compared to 98% of pretreated patients. After adjusting for all baseline characteristics, use of statins prior to PCI was associated with a marked decrease in risk of all CEs (OR = 0.2; CI = 0.06-0.63; P = 0.006). Statin therapy prior to PCI may reduces peri-PCI myonecrosis and late cardiac events. These results need to be confirmed in large prospective randomized trials. (C) 2004 Wiley-Liss, Inc.