| Objective: To investigate clinical effects of clopidogrel combined with simvastatin or fluvastatin on the platelet aggregation rate (PAR), platelet activation marker CD62P and the incidence of major adverse cardiovascular events (MACE) in patients with ACS.Methods: From April 2008 to December 2009, one hundred patients (79 male and 21 female, average age was 61.46±12.84 years old) who had been diagnosed as ACS were enrolled into this study. Patients with bleeding diathesis, thrombocytopenia, and received clopidogrel, statins or GPIIb/IIIa receptor antagonist therapy were excluded. These one hundred cases were randomly divided into two groups, the Group A (n=50, 39 males, 11 females, treated with simvastatin 20mg per night); the Group B (n=50, 40 males, 10 females, treated with fluvastatin 40 mg per night). We collected detailed clinical information including age, gender, risk factors, and pathological changes of coronary artery. We measured the platelet aggregation rate, platelet activation marker—CD62P, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) of the two groups at the time of baseline, 1h, 12h, and 14d after statins treatment. All patients received clopidogrel (a loading dose of 300mg and then 75mg daily), aspirin and Low molecular weight heparin in both groups. The MACE within 14 days were recorded. We used QCA to analyse the lesion and reperfusion of the culprit vessel. We used SAS 8.0 statistics software to analyse all data. The variables were presented as the means and the SD. Differences between two groups means were assessed with the t test. TheΧ2 analysis or the Fisher's exact test were used to test differences between proportions. Statistical significance was indicated by P< 0.05.RESULT:1 There was no significant differences in age, gender, risk factors and pathological changes of coronary artery between the Group A and Group B.2 The expression rate of platelet activation marker CD62p and platelet aggregation rate (PAR) in the Group A at the time of baseline were 26.66±1.86 % and 42.60±18.74 %, and in the Group B were 27.54±1.95 % and 46.59±16.89 %, which indicated that there was no significant differences in the PAR and expression rate of CD62P after 300mg clopidogrel (p>0.05).3 At the time of 1h, 12h, and 14d after treated with statins the expression rate of CD62P and platelet aggregation rate (PAR) in the Group A were 26.00±1.49 % and 38.14±17.72 %, 25.96±1.80 % and 37.83±15.11 %, 20.33±1.67 % and 33.05±15.28 %, and in Group B were 27.15±1.83 % and 46.20±14.83 %, 26.87±1.62 % and 44.66±13.39 %, 21.42±1.78 % and 38.49±13.72 %, which indicated that after 1h treated with statins the expression rate of CD62P and PAR in the two groups were lower than that before treated with statins (p>0.05). After 14d treated with statins the expression rate of CD62P and PAR were still lower than that before treated with statins. At the time of baseline, 1h, 12h, and 14d after treatment with statins the ALT and AST in the Group A were 20.04±9.82 IU/L and 24.52±7.08 IU/L, 20.48±9.17 IU/L and 24.52±6.48 IU/L, 20.34±9.02 IU/L and 24.20±6.60 IU/L, 21.04±8.93 IU/L and 26.17±6.35 IU/L, and in Group B were 17.88±6.51 IU/L and 18.48±7.87 IU/L, 17.92±6.42 IU/L and 18.59±7.84 IU/L, 17.86±6.77 IU/L and 18.55±7.23 IU/L, 18.34±5.85 IU/L and 20.01±8.10 IU/L. There were no significant increase of ALT and AST in the both groups.4 After the above-mentioned medical treatment, the expression rate of CD62P and platelet aggregation rate (PAR) in the two groups were similar (P>0.05). There were no significant differences in the incidence of MACE between two groups.Conclusion:1 ACS patients with loading dose clopidogrel combined with simvastatin or fluvastatin could decrease the MACE, the results in two groups are similar.2 Neither simvastatin with clopidogrel nor fluvastatin with clopidogrel decreases the platelet activity of clopidogrel.3 The platelet aggregation rate (PAR) and CD62P after treatment in both groups are significantly decreased, but there are no differences between two groups after treatment within two weeks, and there are no significant differences of incidence of MACE.
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