| Objective: In recent years, the numbers of patietns with coronary atery disease who taken intervention therapy are increasing rapidly in China. At the same time, studies discovered that PCI-related myocardial injury events were not uncommon. Elevation of myocardiac markers after intervention therapy, even slightly, could affect patients'prognosis and increase mortality during follow-up. Statins, as the first-line pharmaceutical treatment for coronary heart disease, were supportted by series of evidence-based medicine for the effectiveness and safety. Some newly published trials confirmed that enhanced statin therapy before PCI may reduce PCI-related myocardial injury. Our study was designed to discover whether the intensive dose of atorvastatin(40mg) have the effect of perioperative myocardial protection, and evaluate the safety of enhanced statin therapy(40mg/d) in domestic patients as well.Methods: 98 cases were collected in cardiovascular department of our hospital, who were diagnosed as ACS and treated with PCI, from November 2009 to December 2010. Patients were randomized into two groups, emergency group with 47 cases and elective group with 51 cases. Both groups contained 2 subgroups, as the observation group and control group. Patients in observation group were given 40mg atorvastatin 1 hour before PCI, while those in the control group take no intensive dose. Patients in elective group underwent atorvastatin 40mg/d in 3～7d befere PCI. All patients are taking atorvastatin 40mg/d in 2 to 4weeks after PCI. At the end of the experiment, patients'gender, age, risk factors, preoperative liver and kidney function, blood lipids level and other basic conditions, the lesion of coronary artery, perioperative myocardial markers and CRP changes, etc, would be studied. Statistical analyses were carried out with an SPSS 17.0 statistical package program. Significance was assumed when p<0.05.Results:1. There was approximately no difference between the observation group and control group by the basic information as gender, age, risk factors, etc.2. The range of perioperative CK-MB and cTNI in observation group was less distinct than that in control group. In elective group, the incidence of myocardial injury of PCI in observation group was lower than control group,but p>0.05.3. In emergency group, the range of CRP in observation group was higher than that in the control group. whereas, in the elective group, the range of CRP in control group was less distinct than that in observation,but p>0.05.4. Mild-increasing of ALT was found in every group, none of them exceeded 3 times the upper limit, and no patients withdrew. There was no severe adverse effects as significant renal impairment or myopathy.5. During the 4-week follow-up, some patients with emergency PCI occurred major adeverse cardiac events(MACE), both in the observation group and in the control group, but p>0.05. No MACE was fournd in the elective group.Conclusion:1. The intensive dose of atorvastatin(40mg), taken 1 hour right before emengency PCI, may potentially protect the moribund myocyte after acute coronary infartion.2. The intensive dose of atorvastatin(40mg), taken 1 hour right before elective PCI, may probably lower the incidence of PCI-related myocardial injury and infarction.3. The intensive dose of atorvastatin(40mg) taken immediately before PCI could not lower the CRP level after procedure. It reflected that the effect of anti-inflammatory of statins may take some time to play.4. 40mg/d atorvastatin, for short-term enhanced therapy, may be safe for domestic patients with coronary atery disease. |
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