大剂量阿托伐他汀对老年非ST段抬高型急性冠状动脉综合征患者介入术后的影响  

Effects of 80 mg loading dose atorvastatin pretreatment on myocardial protection during percutaneous coronary interventionin in elderly patients with non-ST-segment elevation acute coronary syndrome

作　　者：王学忠[1] 王岳松[1] 汪韶君[1] 樊琴[1] 邵旭武[1] 方永华[1] 董学滨[1] 夏金发[1] 张先林[1] 杨志健 

机构地区：[1]马鞍山市人民医院心内科,安徽马鞍山243000 [2]南京医科大学第一附属医院心脏中心

出　　处：《临床心血管病杂志》2012年第12期934-937,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨大剂量阿托伐他汀对老年非ST段抬高型急性冠状动脉综合征(NSTEACS)经皮冠状动脉介入治疗术(PCI)相关性心肌梗死的影响。方法:将157例老年NSTEACS患者随机分为负荷组81例和对照组76例,负荷组PCI术前12h顿服阿托伐他汀80mg,术后1周每天服用40mg,对照组常规服用阿托伐他汀20mg。两组术前、术后8、12和24h抽取肘静脉血,检测血清肌酸激酶同工酶(CK-MB)、血浆肌钙蛋白I(cTnI)等;随访30d主要不良心脏事件发生率。结果:负荷组CK-MB和cTnI升高发生率均较对照组显著降低(37.9%︰50.5%,P=0.002;5.4%︰22.6%,P=0.041);负荷组PCI相关的心肌梗死发生率较对照组显著降低(12.6%︰33.4%,P=0.035;4.3%︰11.8%,P=0.034);多元回归分析显示,负荷剂量的阿托伐他汀预处理能降低67%的PCI相关性心肌梗死的发生率;两组均未发生死亡和再血管化事件,肝功能损害等不良反应两组差异无统计学意义。结论:PCI术前应用80mg负荷剂量阿托伐他汀治疗,能减少老年NSTEACS患者PCI术相关的心肌梗死发生率,且安全有效。Objective：This study was designed to evaluate the peri-procedural myocardial injury and safety pro- file of atorvastatin in patients over 70 years old with non-ST segment elevation acute coronary syndromes （NSTEACS）. Method：A total of 157 patients over 70 years old with NSTEACS were randomly divided into the pretrcatment with loading dose atorvastatin group or control atorvastatin group. The serum levels of creatine kinase MB （CK-MB） and cardiac troponin I （cTnI） were measured at the baseline and at 8, 12 and 24 h after the procedure. Clinical outcome was measured by taking the main end points of major adverse cardiac events including cardiac death, nonfatal acute myocardial infarction, or revascularization during 30 days follow-up. Result：The pro- portions of patients with the serum levels of CK-MB and cTnI above normal up-limit value and that with PCI relat- ed myocardial infarction at 24 h were significantly lower in high dose atorvastatin group than those in the control dose group （37.9% vs 50.5%, P=0. 002, 5.4% vs 22.6%, P=0. 041; 12.6% vs 33.4%, P=0.035, 4.3% vs 11.8%, P=0. 034）. At multivariable analysis, pre-treatment with atoravastatin conferred an 67% risk reduction of PCI related myocardial infarction （P〈0.05）. No deaths and revascularization were recorded at 30-day follow- up in both groups. Alanine aminotransferase has no difference in two groups. Conclusion：Short-term pretreatment with a high dose of atorvastatin significantly reduces PCI-related myocardial infarction in elderly patients with NSTEACS and enjoys similar safety profile.

关 键 词：急性冠状动脉综合征 非ST段抬高 心肌梗死 老年人 

分 类 号：R543.3[医药卫生—心血管疾病]