Effect Of Treatment And Influence Of Inflammation,Clotheing Factors With Different Dose Atorvastatin On Patients With Acute Coronary Syndrome Around Interventional Treatment Perioperative Period

BackgroundAcute coronary syndrome(ACS) is due to coronary artery atheromatous plaque ruptured, thrombosis lead to coronary artery incompletely or completely block, cause the myocardial ischemia syndrome,which is the main reason of coronary artery disease.Its incidence and mortality is rising year by year,and show younger trend.Coronary intervention can markedly improve the prognosis of patients,but the risk of cardiovascular events renmains high after surgery. Statins play a significant role in primary and secondary prevention of coronary heart disease.Recently,a series of ARMYDA research provides experimental evidence of statins treatment in ACS who accept interventional treatment. Beacause the benefit mechanism of intensive statin treatment in ACS patients is not clear, safety evidence of high-dose statin is less,statin drugs is small dose in China at present.Objective Observe 100 cases ACS who were given different dose atorvastatin around PCI perioperative period,in order to investigate atorvastatin effect of treatment,influence of inflammation,clotting factors and clinical safety.MethodsChose 100 cases of ACS patients from 2010/3 to 2010/11 who hospitalized in cardiovascular medical ward of Guangzhou General Hospital of Guangzhou Military Command and be successfully done emergency or elective PCI. There are 78 cases of men,22 cases of women,57 cases of STEMI,10 cases of NSTEMI,33 cases of UA,with an average age of 61.37±9.92. A randomized control study,100 patients with ACS were randomly divided into A, B groups. A group 50 patients were given doses of atorvastatin 20mg/d. B group 50 patients were given doses of atorvastatin 40mg/d.Treatment time from PCI before surgery to PCI after 1 month. Blood samples were examined at the day before PCI,24h,5d,30d after PCI. And observe major cardiovascular events and side effects of atorvastatin in patients who were followed up for one month.Results1. The level of LDL-C are (3.08±0.67) and (3.02±0.69) mmol/L before PCI, (2.73±0.55) and (2.50±0.56) mmol/L 5d after PCI, (2.06±0.38) and (1.78±0.40) mmol/L 30d after PCI.There are no statistically significant differences of LDL-C level in two groups before PCI(P>0.05). The level of LDL-C in both group decline significantly after PCI for 5d(P<0.05). Comparison between the two groups, the level of LDL-C in 40mg group decline is even greater (P<0.05). The level of LDL-C in both group furtherly decline significantly after PCI for 30d(P<0.05). Comparison between the two groups, the level of LDL-C in 40mg group decline is even greater(P<0.01).2. The level of TC are (5.84±0.85) and (5.97±0.68)mmol/L before PCI, (5.36±0.57) and (5.07±0.38) mmol/L 5d after PCI, (4.22±0.62) and (3.75±0.71) mmol/L 30d after PCI. There are no statistically significant differences of TC level in two groups before PCI(P>0.05). The level of TC in both group decline significantly after PCI for 5d(P<0.05). Comparison between the two groups, the level of TC in 40mg group decline is even greater(P<0.05). The level of TC in both group furtherly decline significantly after PCI for 30d(P<0.05). Comparison between the two groups, the level of TC in 40mg group decline is even greater (P<0.01).3. The level of hs-CRP are (11.61±1.95) and (11.78±2.05) mg/L before PCI, (13.34±2.14) and (12.30±2.04) mg/L 5d after PCI, (11.31±1.53) and (10.46±2.46) mg/L 30d after PCI.There are no statistically significant differences of hs-CRP level in two groups before PCI (P>0.05). The level of hs-CRP in both group rise significantly after PCI for 5d(P<0.01). Comparison between the two groups, the level of hs-CRP in 20 mg group rise is even greater(P<0.05). The level of hs-CRP in 40mg group decline significantly after PCI for 30d(P<0.01), in 20mg group decline to the preoperative level, the difference is not statistically significant (P>0.05). Comparison between the two groups, the level of hs-CRP in 40mg group decline is even greater,(P<0.01).4. The level of TF are (340.77±90.89) and (324.27±107.41) pg/mL before PCI, (373.44±74.25) and (350.04±84.02) pg/mL 5d after PCI, (333.39±65.94) and (282.15±75.85) pg/mL 30d after PCI.There are no statistically significant differences of TF level in two groups before PCI (P>0.05). The level of TF in 20mg group rise significantly after PCI for 5d(P<0.01). The level of TF in 40mg group has no significant changes (P>0.05). Comparison between the two groups, the rise level of TF in two groups has no statistical significant (P<0.05). The level of TF in 40mg group decline significantly after PCI for 30d(P<0.01), in 20mg group decline to the preoperative level, the difference is not statistically significant (P>0.05). Comparison between the two groups, the level of TF in 40mg group decline is even greater (P<0.01).5. The level of TFPI are (44.57±17.47) and (43.35±17.39) ng/mL before PCI, (46.49±17.23) and (42.81±16.65) ng/mL 5d after PCI, (45.80±16.74) and (47.83±17.92) ng/mL 30d after PCI.There are no statistically significant differences of TFPI level in two groups before PCI (P>0.05). The level of TFPI in 20mg group rise significantly after PCI for 5d(P<0.01). The level of TFPI in 40mg group has no significant changes (P>0.05).Comparison between the two groups, the rise level of TF has no statistical significant (P<0.05). The level of TFPI in 40mg group rise significantly after PCI for 30d(P<0.01), in 20mg group decline to the preoperative level (P>0.05). Comparison between the two groups, the level of TFPI in 40mg group rise is even greater, but the difference is not statistically significant (P>0.05).6. The level of cTnI are (0.31±0.11) and (0.29±0.16)ng/mL before PCI, (0.52±0.12) and (0.41±0.07)ng/mL 5d after PCI.There are no statistically significant differences of cTnl level in two groups before PCI(P>0.05). The level of cTnI in both group rise significantly after PCI for 24h(P<0.05). Comparison between the two groups,the level of cTnI in 20mg group rise is even greater (P<0.01).7.In 40mg group,two cases(4%) occur heart failure. In 20mg group, one case occurs again myocardial infarction;five cases heart failure; three cases repeated ischemic anginal attack required hospitalization(18%). Major cardioascular events of 30d in 20mg group are significantly lower than 40mg group (P<0.05).8. No difference in side effects of two group(P>0.05).Conclusion1. Atorvastatin can significantly reduce LDL-C and TC level of ACS patients around PCI periopertive period in short time;the effect in the group of atorvastatin 40mg/d is more significant,LDL-C success rate is higher for 30d and reduce the trend of cardiovascular events for 30d.2.Atorvastatin can reduce the ACS patients inflammation, promote TF/TFPI system to restore balance,in the group of 40mg/d is more significant.