Efficacy Of Statin Pretreatment On PCI-related Inflammation And Myocardial Injury

Background:3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reducatase inhibitors (also known as statins) have been received increasing attention in the role of primary prevention and secondary prevention of CHD,and they have become an important component in the treatment of CHD.Statins were initially used to reduce total plasma cholesterol and regulate blood lipid profile,but recent research have found that statins exert effect on clinical outcome before lowering lipid.The non-lipid lowering effect of statin was called pleiotropic effect,including improve endothelial function,reduce oxidative stress,reduce platelet adhesion,promote atherosclerotic plaque stability, regulate the blood coagulation cascade, direct anti-inflammation and cardioprotection.In recent years, studies have found acute pretreatment with statins,including acute using short-term or acute loading on statin-naive patients and reloading in patients on chronic statin therapy patients can inhibit the PCI-related inflammation,protect myocardia and improve the short-term prognosis. However,there was no related research domestic about whether pretreatment with moderate-does of atorvastain even shorter time could protect myocardia and anti-inflammation.By detecting neutrophil count and their activation markers MPO before and after PCI, This study was in order to observe whether statin pretreat can affect the PCI-related inflammation and the changes of myocardial necrosis markers, investigate the anti-inflammation and cardioproctecion of moderate-doses of atorvastatin pre-treatment short-term.Objective:To investigate the changes of inflammatory biomarkers after PCI and the effect of atorvastatin pretreatment on PCI-related inflammation and myocardial injury.Methods:One hundred and three CHD patients were randomly divided into control group(n=30), low-dose pretreatment group (n=36) and high-dose pretreatment group (n=37). The control group patients were given no atorvastatin before PCI, the other two groups patients were given 20 or 40 mg of atorvastatin tablets for 1-3 d before PCI,respectively. Neutrophil count and hs-CRP as well as cTnⅠof all the patients were examined before and after PCI,and peri-procedural MI was recorded (Peri-procedural MI was defined as cTn I postoperative greater than 3×99th percentile of the upper reference limit). Serum samples preoperative and postoperative of all the patients were collected and placed in-80℃refrigerator, MPO was examined by ELISA.The changes of inflammatory biaomarkers preoperative and postoperative were compared, the relationship between changes of serum MPO and neutrophil count, hs-CRP, cTnⅠ, stent number was analyses and the effects of different doses of atorvastatin pre-treatment on PCI-related inflammation and the incidence of peri-procedural MI were oberseved by statistical methods.Results:(1)MPO, hs-CRP, neutrophil count postoperative were significantly higher than preoperative [(251.67±51.72 vs 215.60±49.48) pmol/L, p＜0.001; (7.15±6.67 vs 2.46±4.38) mg/L, p＜0.001; (5.98±2.29 vs 4.20±1.33) 106/ml, p＜0.001], and the elevated MPO levels was positively correlated to△neutrophil count (r=0.29, p＜0.05), but not with Ahs-CRP, cTnⅠ, stent number. (2) There was no significant difference about the gender composition,BMI, history of high blood cholesterol and diabetes mellitus among the three groups of patients; However, proportion of history of hypertension was highest in the low-dose pretreatment group; in the high-dose pretreatment group, the average age was smallest, the proportion of smoking was highest, stent number was the largest (P<0.05).(3)There is no statistically difference between three group about the changes of hs-CRP, neutrophil count preoperative and postoperative (P>0.05);The MPO elevated degree of high-dose pretreatment group was significantly less than that of control group [(17.33±53.52 vs 56.98±61.57) pmol/L, P＜0.05], but there was no significant difference between the low-dose pretreatment group and control group [(37.88±55.34 vs 56.98±61.57) pmol/L, P=0.173].The incidence of peri-procedural MI in high-dose pretreatment group was the lowest(18.9%),but the there was no significant difference among groups(P=0.018).Conclusion:The neutrophil count, hs-CRP, MPO levels was increased, suggesting the neutrophil mobilization and activation after PCI, accompanied by a degree of systemic inflammatory response; and the elevated MPO levels were positively correlated with the increase of neutrophil cell counts. Atorvastatin 40mg pretreatment of 1 to 3 days before PCI also can inhibit the PCI-related inflammation, and have a certain of protective impact on myocardial injury.