Can a High Reloading Dose of Atorvastatin Prior to Percutaneous Coronary Intervention Reduce Periprocedural Myocardial Infarction?
Can a High Reloading Dose of Atorvastatin Prior to Percutaneous Coronary Intervention Reduce Periprocedural Myocardial Infarction?
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DOI：
10.1185/03007995.2013.834249
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发表时间：
2014-03
影响因子：
2.3
通讯作者：
Latifeh Nafasi;R. Rahmani;A. Shafiee;A. Salari;A. Abdollahi;A. Meysamie
中科院分区：
文献类型：
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作者：
Latifeh Nafasi;R. Rahmani;A. Shafiee;A. Salari;A. Abdollahi;A. Meysamie
摘要背景：围手术期心肌梗死（MI）是经皮冠状动脉介入治疗（PCI）后的常见并发症，他汀类药物已被证明可减少他汀类药物初治患者的MI。我们的目的是确定高剂量的阿托伐他汀是否可以预防已经接受他汀类药物治疗的患者PCI后的MI。材料和方法：在这项三盲对照随机临床试验中，190名已经使用他汀类药物和/或其他降脂药物（如贝特类药物）的择期PCI候选人被随机分配到两个相等的组，在术前24小时内接受阿托伐他汀（80 mg）或安慰剂。分别于术前、术后6 h和12 h检测血清肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTNI）和超敏C反应蛋白（hs-CRP）水平。术后MI定义为基线正常患者肌钙蛋白升高>5倍，或基线测量值升高（伴或不伴胸痛或ST段或T波异常）患者肌钙蛋白升高>20%。结果：阿托伐他汀组MI的发生率为3（3.1%），安慰剂组为10（10.5%）（p = 0.04）。PCI术后6小时内CK-MB升高，干预组为0.6 ± 0.3 mg/dl，安慰剂组为3.0 ± 1.6 mg/dl。此外，干预组6小时和12小时内的cTNI水平显著低于安慰剂组（分别为p = 0.01和0.008）。12小时后，干预组的hs-CRP显著降低（p = 0.004）。结论：PCI前24小时内给予高剂量阿托伐他汀可显著降低围手术期MI的发生率。临床试验注册号：IRCT 201205209768 N1。
Abstract Background: Periprocedural myocardial infarction (MI) is a common complication following percutaneous coronary intervention (PCI) and statins have been shown to reduce MI in statin-naïve patients. We aimed to identify whether a high reloading dose of atorvastatin can prevent MI following PCI in patients who were already being treated with statins. Material and methods: In this triple-blind controlled randomized clinical trial, 190 candidates for elective PCI, who were already using statins and/or other lipid lowering agents such as fibrates, were randomly assigned to two equal groups to receive either atorvastatin (80 mg) or placebo within 24 hours before the procedure. Serum levels of creatinine kinase myocardial isoenzyme (CK-MB), cardiac troponin I (cTNI) and high-sensitive C-reactive protein (hs-CRP) were measured at baseline and then 6 and 12 hours following PCI. Post-procedural MI was defined as troponin elevation >5-fold in patients with normal baseline or >20% in those with elevated baseline measurements with or without chest pain or ST segment or T wave abnormalities. Results: Frequency of MI in the atorvastatin group was 3 (3.1%) vs. 10 (10.5%) in the placebo group (p = 0.04). The CK-MB rise within 6 hours following PCI was 0.6 ± 0.3 mg/dl in the intervention group versus 3.0 ± 1.6 mg/dl in the placebo group. Also, the levels of cTNI within 6 and 12 hours in the intervention group was significantly lower than the placebo group (p = 0.01 and 0.008, respectively). hs-CRP was significantly lower in the intervention group after 12 hours (p = 0.004). Conclusion: Administration of a high reloading dose of atorvastatin within 24 hours before PCI could significantly reduce the frequency of periprocedural MI. Clinical trial registration code: IRCT201205209768N1.