高负荷量阿托伐他汀对PCI围手术期患者的预后影响

目的观察经皮冠状动脉介入术(PCI)前12h服用80mg阿托伐他汀(立普妥),联合术前2h加服40mg阿托伐他汀,降低围手术期患者心肌梗死(MI)的发生率对预后的影响。方法 120例需择期PCI的患者随机分为阿托伐他汀强化组和对照组。阿托伐他汀强化组:给予冠状动脉粥样硬化性心脏病(冠心病,CHD)基础药物治疗的同时,术前12h给予阿托伐他汀80mg,术前2h阿托伐他汀40mg;对照组:仅给予CHD基础药物治疗,其中阿托伐他汀20mg。测定PCI术后18h测肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB),并随访术后30d的主要心血管不良事件(MACE:心血管死亡、再发心肌梗死和靶血管重建)。结果阿托伐他汀强化组心肌梗死标志物水平显著低于对照组,CK-MB和TnI分别为(2.21±0.77)ng/ml比(12.30±7.89)ng/ml(P<0.01),和(0.196±0.112)ng/ml比(1.359±0.142)ng/ml,(P<0.01);且术后30d,阿托伐他汀强化组(3.08%)的主要不良心脏事件明显低于对照组(9.09%)比,P<0.01。结论对于稳定型心绞痛患者,PCI术前12h给予阿托伐他汀80mg,术前2h加服40mg,能显著降低PCI围术期MI的发生率,改善预后。

Effect of Prognosis of Periprocedura PCI Patients with high Loading Dose of Atorvastatin

Objective Take an observation of percutaneous coronary intervention (PCI) 12h prior to taking 80 mg of atorvastatin(Lipitor),combined with the preoperative 2h plus clothing 40mg atorvastatin,it could reduce perioperative myocardial infarction(MI).The incidence and impact on prognosis.Methods 120 patients required elective PCI were randomized into atorvastatin strengthen group and the control group.Strengthening atorvastatin group: given the basis of drug treatment of coronary heart disease(CHD),and given 80mg atorvastatin 12h before surgery,40mg atorvastatin 2h before surgery;control group:only basis for drug treatment given to CHD,including 20mg atorvastatin.Measured: 18h after PCI troponin measurement I(TnI),creatine kinase(CK-MB),and 30d after follow-up major adverse cardiovascular events(MACE: cardiovascular death,recurrent myocardial infarction and target revascularization).Results Atorvastatin enhanced signs of myocardial necrosis were significantly lower than the control group,CK-MB and TnI,respectively(2.21±0.77) ng/ml vs(12.30±7.89)ng/ ml(P<0.01),and(0.196±0.112)ng/ml vs(1.359±0.142)ng/ml,(P<0.01);and after 30d,strengthening atorvastatin group major adverse cardiac events were significantly lower than the control group,3.08% vs 9.09%(P<0.01).Conclusions For patients with stable angina,PCI 12h given preoperative 80mg atorvastatin,added anther 40mg 2h before surgery,and the incidence of PCI perioperative MI rate significantly reduces,and it improve prognosis.