直接PCI术前早期应用大剂量阿托伐他汀对急性心肌梗死冠脉微血管功能及短期预后的影响  

Effects of early Administration of high-dose Atorvastatin on Coronary Microvascular Function and Short-Term Outcome in Patients Treated With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

作　　者：刘鹏[1] 张新勇[2] 周晗[1] 张燕[1] 李靖[1] 汤健民 卢长青[4] 

机构地区：[1]河南省胸科医院心内科,郑州450003 [2]首都医科大学附属北京安贞医院心肺血管疾病医疗抢救中心,北京100029 [3]郑州大学第二附属医院心内科,郑州450014 [4]河南省中医院急诊科,郑州450002

出　　处：《中国医学前沿杂志（电子版）》2011年第2期43-48,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前早期应用大剂量阿托伐他汀(80mg)对急性心肌梗死(acute myocardial infarction,AMI)冠脉微血管功能及短期预后的影响。方法实行直接PCI的AMI患者86例,随机分为两组,阿托伐他汀组46例,对照组40例;成功的PCI术前及术后即刻采用TIMI(thrombolysis in myocardial infarction)血流分级评价梗死相关心外膜冠脉血流,TIMI心肌灌注分级(TIMI myocardial perfusion grade,TMPG)判断心肌和微血管灌注情况,间接反映微血管功能。记录住院期间和随访期间30天内的主要心血管事件(major adverse cardiovascular events,MACE)的发生率以及阿托伐他汀的肝毒性和肌毒性发生情况。结果①PCI术后阿托伐他汀组和对照组的TMPG分级均较术前有显著性差异(分别χ2=25.514,P<0.001;χ2=8.348,P=0.039),但阿托伐他汀组TMPG较对照组改善更明显(χ2=8.374,PPP==00..003399))。。②②随随访访的的3300天天内内,,共共1199例例患患者者发发生生MMAACCEE,,占占2222..11%%,,其其中中阿阿托托伐伐他他汀汀组组66例例,,占占1133..00%%,对照组13例,占32.5%(χ2=4.706,PPP==00..003300));;阿阿托托伐伐他他汀汀组组内内PPCCII术术后后TTMMPPGG33级级的的患患者者发发生生MMAACCEE3/27例,而对照组6/14例(42.9%vs.11.1%,χ2=5.423,PPP==00..002299));;在在达达到到TTMMPPGG33级级的的患患者者,,对对照照组发生MACE的危险度大约为阿托伐他汀组的3.857倍(RR3.857,95%CI:1.131～13.149)。③随访期间,阿托伐他汀组和对照组均无肌毒性和肝毒性事件发生。结论直接PCI术前早期应用大剂量阿托伐他汀(80mg)对改善AMI冠脉微血管功能及短期预后是安全有效的。Objective To investigate the effects of early administration of high-dose atorvastatin(80 mg) on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary Intervention for acute myocardial infarction. Methods 86 consequent AMI patients treated with primary PCI with were divided into atorvastatin group(n=46) and control group(n=40). The infarct-related artery flow of epicardium was classified in compliance with the TIMI criteria; whereas myocardial and microvascular perfusion was assessed using the TMPG. The incidence of the MACEs and the cytotoxicity and hepatotoxicity of atorvastatin were respectively recorded in 30 days follow-up period. Results The culprit vessels were targeted with primary PCI in 84 patients. ①Either the study group or the control group showed better TMPG immediately after PCI (χ2=25.514, P<0.001; χ2=8.348, P=0.039, respectively), compared with pretreatment. However, the post-PCI TMPG of the study group was obviously much better than that of the control group(χ2=8.374,P=0.039). ②Compared with the control group, either for all patients, the 30-day composite MACE rate was lower in the study group (13.0% vs. 32.5%, P<0.05), or for the TMPG 3 patients (42.9% vs. 11.1%, χ2=5.423, P=0.029). Moreover, the relative risk of MACE for patients with control group was 3.857(RR 3.857, 95% CI: 1.131-13.149) compared with patients with study group. ③There was no significant difference between the atorvastatin and the control group for the cytotoxicity and hepatotoxicity. Conclusion Early administration of high-dose atorvastatin(40 mg) can improved coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary Intervention for acute myocardial infarction, and it was efficacy and safety.

关 键 词：阿托伐他汀 他汀 心肌梗死 血管成形术 微循环 危险评估 

分 类 号：R542.22[医药卫生—心血管疾病]