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目的探讨经皮冠状动脉介入治疗(PCI)术前给予大剂量阿托伐他汀对于急性冠状动脉综合征(ACS)高危病变无复流发生率及近期临床预后的影响。方法 164例高危ACS患者随机分为大剂量阿托伐他汀试验组(n=84)和常规治疗组(n=80),均于入选后3～5 d后行PCI治疗。比较两组间基础临床资料、PCI前后病变血管血流TIMI分级、术后12 h血清肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、出血事件和血小板减少及30 d主要心血管事件(MACE)的发生率。结果两组间基础临床资料比较差异无统计学意义,试验组应用大剂量阿托伐他汀后PCI术前病变血管前向血流达到TIMI 3级的比率高于常规治疗组(85.7%vs 65.0%,P<0.05),术后TIMI 3级血流获得率试验组较常规治疗组高(84.5%vs 62.5%,P<0.05),差异有统计学意义;术后试验组cTNT和CK-MB升高超过正常上限2倍发生率较对照组明显减低(2.4%vs 11.3%,P<0.05);PCI术后30 d MACE发生率试验组明显降低(3.6%vs 17.5%,P<0.05),差异有统计学意义。两组肝、肾功能变化和横纹肌溶解症比较差异无统计学意义(P>0.05)。结论 ACS患者择期介入治疗术前应用大剂量阿托伐他汀是安全有效的,能够提高PCI术前冠状动脉前向血流,术后无复流现象发生,并减少PCI术后的心肌损伤,改善近期临床预后。
Objective To investigate the effect of high-dose atorvastatin administered before percutaneous coronary intervention (PCI) on the incidence of no-reflow and recent clinical prognosis in high-risk patients with acute coronary syndrome (ACS). Methods A total of 164 high-risk ACS patients were randomly divided into high-dose atorvastatin group (n = 84) and conventional treatment group (n = 80), all of whom were treated with PCI 3 to 5 days after their enrollment. Baseline clinical data were compared between the two groups, TIMI grade of vascular lesion before and after PCI, serum Troponin T (cTnT), creatine kinase MB (CK-MB), hemorrhage and thrombocytopenia 12 d after operation and 30 d The incidence of major cardiovascular events (MACE). Results There was no significant difference in basic clinical data between the two groups. The rate of TIMI 3 grade in pre-PCI blood flow before PCI in trial group was higher than that in routine treatment group (85.7% vs 65.0% , P <0.05). The postoperative TIMI grade 3 blood flow acquisition rate was significantly higher in the experimental group than in the conventional treatment group (84.5% vs 62.5%, P <0.05), and the difference was statistically significant. The postoperative cTNT and CK- The incidence of MACE exceeding the upper limit of normal was significantly lower than that of the control group (2.4% vs 11.3%, P <0.05). The incidence of MACE on the 30th day after PCI was significantly lower in the experimental group (3.6% vs 17.5%, P <0.05) There is statistical significance. Two groups of liver and kidney function changes and rhabdomyolysis compared with no significant difference (P> 0.05). Conclusions Elective high-dose atorvastatin is safe and effective before elective interventional therapy in patients with ACS, which can improve the antegrade coronary flow, the no-reflow phenomenon after PCI and reduce the myocardial damage after PCI, Recent clinical prognosis.