Impact Of Preoperative Single Intensive Statin On The Effect Of Myocardial Protection And MACEs In Patients With Non-ST-segment Elevation Acute Coronary Syndrome After Percutaneous Coronary Intervention

Objective:To observe the change of cardiac troponin I、highly sensitive C-reaetive protein(hs-CRP)and lipide in preoperative and post operative,and investigate the myocardial protection effect of a single high-dose(80mg) fluorine laval statin intensive treatment before percutaneous coronary intervention(PCI) in patients with non-ST-segment elevation acute coronary syndrome after PCI.Methods:370patients,first diagnosed NST-ACS,All cases were diagnosed by CAG and received PCI treatment and who from February2011to February2012in the second affiliated hospital of TianJin Medical University.Of the370patients,76patients refused to participate in the study,the remaining294patients were enrolled in the study.Patients were assigned in a1:1ratio with a computer-generated randomization sequence.The patients were randomly divided into2groups:Intensive statin therapy group (n=147) which took fluorine laval statin80mg12h before PCI operation, only including124patients with UA and23patients with NSTEMI;routine statin therapy group(n=147), only including119patients with UA and28patients with NSTEMI. The subjects were advised to consume a low-salt and low-fat diet with aspirin,nitrates, clopidogrel, beta-blockers and angiotensin converting enzyme inhibitors, et al. hs-CRP,cardiac troponin I and lipide were assessed before and24h after PCI.The incidence of MACEs and statin adverse reactions were compared duration of hospital stay,30-day follow-up, half and a year.Results:1.No significant differences were observed in the baseline clinical characteristics, coronary risk profiles such as sex ratio,mean age, smoking,hypertension and diabetes mellitus;further including PCI surgical history and the number of coronary artery diseased vessels between the two groups (p>0.05).2.cTnI,at the time point of24h after PCI, elevated in both intensive statin therapy group (0.44±0.24ng/ml vs0.24±0.11ng/ml,p<0.001) and routine statin therapy group (0.78±0.43ng/ml vs0.27±0.15ng/ml,p<0.001);but lowered more significant in intensive statin therapy group than in group routine statin therapy(p<0.05)3. hs-CRP,at the time point of24h after PCI, elevated in both intensive statin therapy group(5.86±3.75mg/l vs3.11±1.51mg/l,p<0.001)and routine statin therapy group (9.32±5.10mg/l vs3.03±1.60mg/l,p<0.001);but lowered more significant in intensive statin therapy group than in group routine statin therapy(p<0.05)4.The blood lipid for patients in preoperative and post operative were no significant differences in both group (p>0.05).5.Pretreatment with a high dose of statin decreased the incidence of MACEs within30days (p<0.05).But the levels were no significant differences in both group, duration of hospital stay, half and a year follow-up.(p>0.05).6. In terms of the adverse effects of fluorine laval statin,there were no significant differences in both group, duration30days and a year follow-up.(p>0.05).Conclusion:1.The levels about cTnl are increasing after PCI in the patient of NSTE-ACS, It implied that there may participate the process of myocardial injury caused by PCI. The statins used before PCI should reduce the increased range of cTnI,performe the protection of the damaged cardiac muscle.2. The levels about hs-CRP are increasing after PCI in the patient of NSTE-ACS, It implied that the inflammatory may be induced caused by PCI. The statins used before PCI should reduce the increased range of hs-CRP, performe anti-inflammatory effects.3. The blood lipid for patients in preoperative and post operative were no significant differences in intensive statin therapy group, It implied that the benefits resulting from intensive statin therapy may be independent of their lipid-lowering effect.4. Intensive statin therapy can decrease the incidence of MACEs in30-day follow-up.But there were no significant differences in intensive statin therapy group duration of half and a year follow-up, It implied that intensive statin therapy may had a short-term myocardial protection.5. Follow-up a year, pretreatment with a high dose of fluorine lava statin did not significantly increased the adverse reactions in patients with a certain security.