Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction
Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction
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DOI：
10.1016/j.ehj.2004.07.017
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发表时间：
2004-10-01
影响因子：
39.3
通讯作者：
Scarpato, P
中科院分区：
文献类型：
--
作者：
Briguori, C;Colombo, A;Scarpato, P
围手术期非Q波心肌梗死是经皮冠状动脉介入治疗（PCI）的常见并发症。据推测，他汀类药物可能会降低PCI后心肌损伤的发生率。方法和结果451例择期PCI患者，而不是他汀类药物被随机分配到没有治疗或他汀类药物治疗。在手术前至少3天开始他汀类药物给药。通过分析干预前、干预后6 h和12 h的肌酐激酶心肌同工酶（CK-MB：正常值上限[ULN] 3.5 ng/ml）和心肌肌钙蛋白I（cTnI，ULN 0.10 ng/ml），评估围手术期心肌损伤的发生率。大面积非Q波心肌梗死定义为CK-MB升高>5倍ULN单独或与胸痛或ST段或T波异常相关。PCI后他汀组CK-MB峰值中位数为1.70（四分位数范围1.10-3.70）ng/ml，对照组为2.20（1.30-5.60）ng/ml（p = 0.015）。PCI术后cTnI的中位峰值为0.13（0.05-0.45）ng/ml。他汀组为0.21（0.06-0.85）ng/ml，对照组为0.21（0.06-0.85）ng/ml（p = 0.033）。他汀类药物组和对照组的大面积非Q波心肌梗死发生率分别为8.0%和15.6%（p = 0.012：OR = 0.47; 95% CI = 0.26-0.86）。他汀类药物组cTnI升高>5倍ULN的发生率为23.5%，对照组为32%（p = 0.043：OR = 0.65; 95% CI = 0.42-0.98）。Logistic回归分析显示，术中血管造影并发症是PCI术后CK-MB升高>5倍ULN的独立预测因素（OR = 9.36; 95%CI = 3.06-28.64; p < 0.001），他汀类药物治疗前年龄>65岁（OR = 2.58; 95% CI = 1.09-6.11; p = 0.031）。结论术前他汀类药物治疗可降低PCI术后大面积非Q波心肌梗死的发生率。(C)2004年欧洲心脏病学会。由爱思唯尔有限公司出版。保留所有权利。
Aims Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI.Methods and Results Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure. Incidence of periprocedural myocardial injury was assessed by analysis of creatinine kinase myocardial isoenzyme (CK-MB: upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (cTn I, ULN 0.10 ng/ml) before, 6 and 12 h after the intervention. A large non-Q-wave myocardial infarction was defined as a CK-MB elevation >5 times ULN alone or associated with chest pain or ST segment or T wave abnormalities.Median CK-MB peak after PCI was 1.70 (interquartile ranges 1.10-3.70) ng/ml in the Statin group and 2.20 (1.30-5.60) ng/ml in the Control group (p = 0.015). Median peak of cTnI after PCI was 0.13 (0.05-0.45) ng/ml. in the Statin group and 0.21 (0.06-0.85) ng/ml in the Control group (p = 0.033). The incidence of a large non-Q-wave myocardial infarction was 8.0% in the Statin group and 15.6% in the Control group (p = 0.012: OR = 0.47; 95% CI = 0.26-0.86). The incidence of cTnI elevation >5 times ULN was 23.5% in the Statin group and 32% in the Control group (p = 0.043: OR = 0.65; 95% CI = 0.42-0.98). By logistic regression analysis, the independent predictors of CK-MB elevation >5 times ULN after PCI were intra-procedural angiographic complications (OR = 9.36; 95% CI = 3.06-28.64; p < 0.001), statin pre-treatment (OR = 0.33; 95% CI = 0.13-0.86; p = 0.023) and age >65 years (OR = 2.58; 95% CI = 1.09-6.11; p = 0.031).Conclusions Pre-procedural statin therapy reduces the incidence of large non-Q-wave myocardial infarction after PCI. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.