Preoperative lipid-control with simvastatin reduces the risk of postoperative thrombocytosis and thrombotic complications following CABG
Preoperative lipid-control with simvastatin reduces the risk of postoperative thrombocytosis and thrombotic complications following CABG
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DOI：
10.1016/s1010-7940(99)00034-2
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发表时间：
1999-04-01
影响因子：
3.4
通讯作者：
Christenson, JT
中科院分区：
文献类型：
--
作者：
Christenson, JT
目的：早期研究表明，冠状动脉旁路移植术(CABG)术后常发生血小板增多症，这可能与血脂紊乱有关。进行了一项前瞻性随机研究，以评估术前使用HMG-CoA还原酶抑制剂(Zocor(R))辛伐他汀进行血脂控制是否降低了术后血小板增多的风险。方法：77例有症状的冠心病合并高胆固醇血症(总胆固醇大于或等于6.2 mmoL/L)患者，随机分为两组，分别行冠状动脉旁路移植术(I组，n=37)和辛伐他汀治疗(20 mg/d，n=40)。结果：患者特征和手术数据在两组之间没有差异。I组患者的血清胆固醇、胆固醇/高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、载脂蛋白A1和纤溶酶原均显著高于手术前的n组。其他实验室参数也没有不同。结果：在II组，辛伐他汀显著降低总胆固醇和胆固醇/高密度脂蛋白-胆固醇比值(分别为-2和-29%)。术后血小板增多(血小板数大于或等于40万个/亩L)，I组81%(30/37)，II组3%(1/40)，P<；0.0001。I组术后7d后心肌梗死的发生率高于II组，分别为14%和0%。术后一过性肾功能衰竭的发生率，I组为24%，II组为8%。其他术后并发症和实验室数据无差异。结论：这项研究再次强调了在确诊的冠状动脉疾病患者中使用HMG-CoA还原酶抑制剂(例如Zocor(R))控制血脂的重要性。首次显示冠状动脉旁路移植术前应用辛伐他汀控制血脂可降低术后血小板增多的风险，从而降低血栓并发症的风险。(C)1999 Elsevier Science B.V.保留所有权利。
Objective: It has earlier been suggested that postoperative thrombocytosis frequently occur after coronary artery bypass grafting (CABG) and may be linked to lipid disturbances. A prospective randomized study was undertaken to evaluate if preoperative lipid-control, using HMG-CoA-reductase inhibitor (Zocor(R)), simvastatin, reduces the risk of postoperative thrombocytosis. Methods: Seventy-seven patients with symptomatic coronary artery disease and hypercholesterolemia (total cholesterol greater than or equal to 6.2 mmol/l), planned for CABG where randomly assigned to; undergo CABG without preoperation lipid control (group I, n = 37) or undergo simvastatin-treatment (20 mg daily) to control their lipids (4 weeks) prior to CABG (group II, n = 40). Results: Patient characteristics and operation data did not differ between the groups. Serum-cholesterol, cholesterol/HDL-cholesterol, LDL-cholesterol, Apolipoprotein A1 and Plasminogen were all significantly higher in group I patients compared with group n just prior to surgery. Other laboratory parameters did not differ. Results: In group II, total cholesterol and cholesterol/HDL-cholesterol quota were significantly lowered by simvastatin (-2 and -29%, respectively). Postoperative thrombocytosis (platelet counts greater than or equal to 400 000/mu l) occurred significantly more frequently in group I 81% (30/37) compared with 3% (1/40) in group II, P < 0.0001. Myocardial infarction after the 7th postoperative day was more often diagnosed in group I, 14 vs. 0% in group II. Postoperative transient renal failure occurred also more frequently in group I, 24% compared with 8% in group II. Other postoperative complications and laboratory data did not differ. Conclusions: This study once again underlines the importance of lipid control using HMG-CoA-reductase inhibitors (e.g. Zocor(R)) in patients with established coronary artery disease. For the first time it is shown that lipid-control with simvastatin prior to CABG reduces the risk of postoperative thrombocytosis, thus lowers the risk for thrombotic complications. (C) 1999 Elsevier Science B.V. All rights reserved.