摘要
目的了解直接PCI术前负荷剂量阿托伐他汀治疗对ST段抬高型心肌梗死患者冠脉血流灌注、短期心血管不良事件以及安全性的影响。方法入选2010年1月至2011年3月在北京大学第一医院就诊且既往未服用他汀类药物的ST段抬高型心肌梗死患者83例,根据是否于直接PCI术前应用负荷剂量阿托伐他汀治疗分为强化组(阿托伐他汀80mg,41例)和对照组(无他汀预处理,42例),术后均接受阿托伐他汀20mg,1次/天治疗。主要终点为术后即刻TIMI血流分级、校正的TIMI血流帧数、TIMI心肌灌注分级。次要终点为术后30天的心血管死亡、非致死性心肌梗死和靶血管血运重建的复合终点。安全性终点为出院前肝酶、肌酸激酶以及肾功能水平。结果强化组相比对照组术后即刻TIMI3级血流比例显著增加(87.8%比64.3%,χ2=6.28,P=0.02),校正的TIMI血流帧数明显减低(21.72±9.42比32.64±15.51,t=-3.87,P<0.001),而强化组TIMI心肌灌注分级亦明显高于对照组(2.71±0.64比2.15±0.74,t=3.68,P<0.001)。次要终点中,强化组和对照组分别有4.9%和4.8%出现主要心血管不良事件(χ2=0.001,P=0.926)。出院前两组丙氨酸氨基转移酶、肌酸激酶以及肌酐水平差异无统计学意义。多因素分析显示,在校正年龄、性别、吸烟、糖尿病、血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂、后扩张、血栓抽吸术等因素后,术前应用阿托伐他汀80mg负荷剂量仍为避免出现慢血流/无复流的独立预测因素(OR=0.22,95%CI0.06～0.87,P=0.03)。结论强化阿托伐他汀负荷剂量可以改善ST段抬高型心肌梗死患者直接PCI术后的冠状动脉血流及心肌灌注,并且不增加不良反应的发生率。
Objective This study sought to investgate the impact of high loading-dose atorvastatin pre-treatment in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI） on coronary reperfusion, short-term clinical outcome and safety. Methods We collected consecutive patients with STEMI in our hospital from January 2010 to March 2011,83 patients who did not receive any statin therapy before admission and only received atorvastatin after admission were included. Patients were divided in 2 groups ：those who received atorvastatin 80 mg before primary PCI （n = 41 ） and those who did not （n = 42 ）. The primary end point included thrombolysis in myocardial infarction flow grade, corrected thrombolysis in myocardial infarction frame count, and myocardial blush grade after PCI. Secondary end point was 30-day incidence of MACE including cardiovascular death, nonfatal MI, and target vessel revascularization. The safety end point was the level of liver enzyme, creatine kinase and serum creatinine. Results Baseline clinical and procedural characteristics were similar between the 2 groups. The proportion of thrombolysis in myocardial infarction flow grade 3 was higher in the 80-mg atorvastatin arm （ 87. 8% vs. 64. 3% ,X2 = 6. 28, P = 0.02 ）, and corrected thrombolysis in myocardial infarction frame count was also lower in the 80-mg atorvastatin arm （21.72 ±9.42 vs. 32. 64 ±15.51, t = -3. 87,P 〈0. 001）. Simultaneously, myocardial blush grade were higher in the 80 mg atorvastatin arm （2.71±0.64 vs. 2.15±0.74,t =3.68,P〈0.001）. MACE occurred in 2 （4.9%） and 2 （4.8%） patients in the atorvastain 80 mg pre-treatment and control ann, respectively （X2 = 0. 001, P = 0. 926 ）. There was not significant difference of liver enzyme, ereatine kinase and serum creatinine between 2 groups. Multivariate analysis showed that high loading-dose atorvastatin pre-treatment was associated with an odds ratio of 0. 22 （ 95% confidence interval 0. 06 to 0. 87, P = 0. 03 ） for slow reflow or no reflow after PCI. Condusions High loading-dose atorvastatin pre-treatment may produce an optimal result for STEMI patients undergoing PCI by improving microvascular myocardial perfusion without increasing the risk of side- effect.
出处
《中国介入心脏病学杂志》
2013年第1期41-45,共5页
Chinese Journal of Interventional Cardiology
关键词
心肌梗死
阿托伐他汀
血管成形术
经腔
经皮冠状动脉
冠状动脉循环
Myocardial infarction
Atorvastatin
Angioplasty, transluminal, percutaneous coronary
Coronary circulation
作者简介
通信作者：洪涛，Email：dr_hongtao@163．com
