阿托伐他汀或瑞舒伐他汀与氯吡格雷合用在非ST段抬高型急性冠状动脉综合征患者支架置入术后的近期疗效比较

目的比较阿托伐他汀或瑞舒伐他汀与氯吡格雷合用在非ST段抬高型急性冠状动脉综合征(NSTE-ACS)支架置入术后患者的近期疗效。方法共154例NSTE-ACS的患者接受支架置入术后,随机分为服用阿托伐他汀组(74例)及服用瑞舒伐他汀组(80例),术前服用阿司匹林(100mg)5 d、氯吡格雷(75 mg)5 d以上或术前12 h以上顿服氯吡格雷300 mg及阿司匹林片300 mg,于术前服抗血小板药前、手术当天、术后3、7 d及术后1、6个月抽取静脉血测定二磷酸腺苷(ADP)(浓度为10μmol/L)诱导的血小板聚集功能,观察住院期间及6个月的主要不良心脏事件(MACE)。结果两组患者的临床基线资料及服药情况差异无统计学意义,服用氯吡格雷(75 mg)5 d或顿服300 mg能达到明显的血小板聚集率抑制作用,血小板聚集率在阿托伐他汀组由基线的(57.2±10.3)%降至手术当日的(32.5±11.2)%,而瑞舒伐他汀组分别为(59.1±9.8)%和(30.4±10.1)%(均为P<0.01),而且这种抑制作用稳定持续至6个月之后。6个月时两组间总的MACE发生率差异无统计学意义(13.0%比15.0%,P>0.05),两组心原性死亡、非致死性心肌梗死、靶血管重建术、支架内血栓形成及出血事件差异均无统计学意义(均为P>0.05)。结论接受冠脉支架置入术的NSTE-ACS患者,服用阿托伐他汀或瑞舒伐他汀后,短期内未发现对氯吡格雷抗血小板作用产生显著影响,且两组间的近期疗效相近。

Comparison of short-term effects of atorvastatin or rosuvastatin combined with clopidogrel in coronary stenting patients with non-ST segment elevation acute coronary syndrome

Objective To Compare the short-term effects of atorvastatin or rosuvastatin combined with clopidogrel in coronary stenting patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS). Methods One hundred and fifty-four coronary stenting patients with NSTE-ACS were randomly divided into atorvastatin group(n=74) or rosuvastatin group(n=80).Aspirin 100 mg and clopidogrel 75 mg once daily were administrated for at least 5 days,or aspirin 300 mg and clopidogrel 300 mg loading dose 12 hours before percutaneous coronary intervention(PCI).Adenosine diphosphate(ADP)(10 μmol/L) induced platelet aggregation ratio(PAR) was measured before aspirin and clopidogrel use,the day of PCI,and 3 d,7 d,and one month after PCI.The main adverse cardiac events(MACE) in hospital and 6 months after PCI were evaluated. Results Baseline data between two groups were similar.Both groups achieved significant platelet inhibition PAR from(57.2±10.3)% at baseline to(32.5±11.2)% the day of PCI and from(59.1±9.8)% to(30.4±10.1)% in rosuvastatin group,both P<0.01] and last for six month after PCI.MACE rate had no difference between two groups(13.0% in atorvastatin group vs.15.0% in rosuvastatin group,P>0.05). Conclusions Both atorvastatin and rosuvastatin have no significant influence on platelet inhibition effect of clopidogrel.The short-term effects of atorvastatin or rosuvastatin combined with clopidogrel in coronary stenting patients with NSTE-ACS are similar.