| Objective: In recent years, It have confirmed that loading-dose statintherapy before PCI can reduce perioperative myocardial injury to improveprognosis and decrease the incidence of short-term adverse cardiac events,especially for stable angina or acute coronary syndrome patients. However, themechanism and effects of loading-dose atorvastatin therapy before emergengcyPCI for acute ST segment elevation myocardial infarction (STEMI) is remainuncertain. So we design a randomized clinical trial to investigate the efficacy ofloading-dose atorvastatin tratement on anti-inflammation, stable plaque, improvecardiac function, reverse ventricular remodeling and MACE during1year offollow-up.Methods: From May1.2010to July31.2012, STEMI patients whoprepared to perform emergency PCI within12hours of pain onset were includedin our study. Patients were randomly divided into three groups and writtenconsent was obtained from them. Group A: received atorvastatin80mg loadingdose before PCI then followed by40mg daily for one month and a maintenancedose of20mg daily thereafter; Group B: received atorvastatin40mg daily afterPCI for one month and a maintenance dose of20mg daily thereafter; Group C:received atorvastatin20mg daily after PCI. Determination of indicators:1hs-CRPMMP-9and BNP were detected pre-operation, post-operation7day,1and6month.2LVEF and LVEDD were detected at2nd day,3and6month after PCI.3Thein-hospital and1month,1year incidence of MACE (Major Adverse CardiacEvents：death non-fatal MI and revascularization) were also observed.4Safetyassessment contained muscle pain and rhabdomyolysis during taking medications,liver enzymes increased which was caused by statins (more than3times theupper limit of normal or above to stop medication). Moreover, gastrointestinal reactions were recorded.Results:204consecutive patients with STEMI who underwent diagnosticcoronary angiography were screened. A total of181STEMI patients wereadmitted during the study. Of the181patients,6patients were excluded becausethey had not to undergo emergency PCI,12patients refused to participate in thetrial. Eligible patients (n=163) were randomly assigned to A group (n=54), Bgroup (n=51), C group (n=58).1The difference in baseline data of3group patients was not statisticallysignificant and comparable.2Hs-CRP was compared among three groups: there were no significantdifferences in hs-CRP among three groups before PCI (P>0.05).7days after PCI,the hs-CRP was6.21±1.31mg/L,7.37±1.74mg/L and7.24±1.70mg/L in the threegroups respectively. The hs-CRP was significantly lower in A group than those inB group and C group (P＜0.05).There was no difference between B group and Cgroup (P>0.05).1month after PCI, The hs-CRP was3.06±1.49mg/L,4.14±1.40mg/L and4.95±1.43mg/L in the three groups respectively. The hs-CRP wassignificantly lower in A group than those in B group and C group (P＜0.05). Thehs-CRP was also significantly lower in B group than that in C group (P＜0.05).6month after PCI, The hs-CRP was1.96±0.98mg/L,2.10±0.82mg/L and2.54±0.71mg/L in the three groups respectively. The hs-CRP was significantlylower in A group than those in B group and C group (P＜0.05).The hs-CRP wasalso significantly lower in B group than that in C group (P＜0.05).3MMP-9was compared among three groups: there were no significantdifferences in MMP-9among three groups before PCI (P>0.05).7days after PCI,the MMP-9was1.05±0.37ng/mL,1.13±0.62ng/mL and1.28±0.45ng/mL in thethree groups respectively. The MMP-9was significantly lower in A group thanthat in C group (P＜0.05).There was no difference between B group and C group,A group and C group (P>0.05).1month after PCI, The MMP-9was0.86±0.43ng/mL,0.87±0.25ng/L and1.05±0.35ng/L in the three groups respectively. TheMMP-9was significantly lower in A group and B group than that in C group (P＜0.05). There was no difference between A group and B group (P>0.05).6 month after PCI, the MMP-9was0.63±0.28ng/L,0.73±0.20ng/L and0.93±0.26ng/L in the three groups respectively. The MMP-9was significantly lower in Agroup and B group than that in C group (P＜0.05). There was no differencebetween A group and B group (P>0.05).4BNP was compared among three groups: there were no significantdifferences in BNP among three groups before PCI (P>0.05).7days after PCI,the BNP was555.62±122.82pg/mL,653.41±167.36pg/mL,658.03±206.47pg/mL in the three groups respectively. The BNP was significantly lower in Agroup than those in B group and C group (P＜0.05).There was no differencebetween B group and C group (P>0.05).1month after PCI, The BNPwas397.71±87.98pg/mL502.52±131.52pg/mL and579.59±182.42pg/mL in thethree groups respectively. The BNP was significantly lower in A group than thosein B group and C group (P＜0.05). The BNP was also significantly lower in Bgroup than that in C group (P＜0.05).6month after PCI,The BNP was320.72±47.45pg/mL,371.92±80.92pg/mL and433.95±124.23pg/mL in thethree groups respectively. The mmp-9was significantly lower in A group thanthose in B group and C group (P＜0.05). The mmp-9was also significantly lowerin B group than that in C group (P＜0.05).5LV funtion were compared among three groups: there were no significantdifferences in LVEF among three groups at2day and3month after PCI (P>0.05). After6month The LVEF was54.95±6.50%，55.10±6.50%and50.95±5.67%in the three groups respectively. The LVEF was significantly higherin A group and B group than that in C group.There was no significant differencein LVEF between group A and group B (P＞0.05). There was no significantdifferences in LVEDD among three groups at2day3month and6month afterPCI (P＞0.05).Compared with initial after6months: LVEF was significantly increased ingroup A from2days to3month (47.89±5.67%vs54.73±2.10%, P＜0.05) and2days to6month (47.89±5.67%vs54.95±6.50%, P＜0.05). LVEF wassignificantly increased in group B from2nd days to6month (47.15±7.84%vs55.10±6.50%, P＜0.05. But there was no significant difference in group C (P＞ 0.05). There was significant decreased in LVEDD form2days to6month(51.05±7.38mm vs47.50±3.83mm; P＜0.05), There was no significant differencein LVEDD among the group B and group C respectively (P＞0.05).6MACE were compared among three groups: During in-hospital and1month of follow-up, MACE occurred in3.70%,5.88%and6.89%of in threegroups respectively and there were no significant differences among threegroups(P＞0.05). During1year of follow-up, MACE occurred in11.11%,25.49%and25.86%of in three groups respectively and there were no significantdifferences among three groups (P＞0.05).7Monitoring drug safety: there were no significant differences among threegroups in ALT, AST and CK at any time point (P>0.05).Conclusion:80mg atorvastatin before PCI and40mg atorvastatin after PCI therapy could:1Reduce the inflammatory response and increase the stability of theatherosclerotic plaque.2Improve left ventricular systolic function and reverse ventricularremodeling.3No significant decrease the MACE at1years, but show a trend thatcould reduce mace. |
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