Efficacy Of Early Administration Of High-dose Atorvastatin On Myocardial No-reflow And Short-term Cardiac Function In Patients Treated With Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction

Objective: To investigate the effects of early administration of high-doseatorvastatin (80mg) on myocardial no-reflow and short-term cardiac functionin patients treated with primary percutaneous coronary Intervention (PCI) foracute myocardial infarction (AMI).Methods:72patients who were diagnosed with AMI at first time andtreated with primary PCI successfully were recruited from the secondDepartment of Vasculocardiology, Third Hospital of Hebei Medical Unive-rsity from September2012to December2013. These patients were30~80years old.54patients were diagnosed with ST segment elevation myocardialinfarction, while18patients were Non-ST segment elevation myocardialinfarction (NSTIM). It was not included that those patients with AMI comb-ination with other diseases, such as acute left heart failure, cardiogenic shock,active liver disease, severe liver or kidney function insufficiency and so on.These patients were randomly divided into two groups: Loading dose group(80mg atorvastatin prior to PCI and20mg/d atorvastatin after PCI; n=38),regular dose group (only20mg/d atorvastatin after PCI; n=34). Two groupsof patients were pretreated with a loading dose of aspirin (300mg) andclopidogrel (600mg) before PCI, and administered with aspirin, clopidogreland low molecular heparin in hospital, then received the basic treatment withsome medicines such as IIb/Ⅲa receptor blockers, angiotensin convertingenzyme inhibitor/angiotensin receptor blockers (ACEI/ARB), beta blockers,and so on. The clinical characteristics are summarized for all patientsaccording to the random number. There are gender, age, smoking, drinking,basic diseases (including hypertension, diabetes, blood lipid metabolic abno- rmalities), number of damaged vascular, infarct-related artery, duration ofchest pain, and so on. After signing informed consent book, infarct-relatedartery were opened within90min for all patients. Two experienced interv-entional physicians will evaluate the TIMI (thrombolysis in myocardialinfarction) flow grade of infarct-related artery immediately once PCI weresuccessful performed. The rate of no-flow was recorded to evaluate themicrocirculation and myocardial perfusion according to the TIMI myocardialperfusion grade (TMPG). Plasma BNP levels were tested and collected whenpatients were admitted to hospital and fasting on the first day after operation.Left ventricular ejection fraction (LVEF) value according to cardiac colorultrasound in a month after operation was recorded. Both of the two indexeswere used to evaluate the short-term heart function impairment and recovery.The main end point of experimental research was the rate of no-flow in PCIand Myocardial perfusion level. The secondary end point was the effects ofearly administration of high-dose atorvastatin on short-term cardiac functionin patients treated with emergency PCI.Results:1Comparison of general characteristicsThe baseline characteristics (Includegender, age、smoking history、drinking history、history of diabetes、history of hypertension、history ofabnormal lipid metabolism、BNP levels at admission, time of onset, infarct-related artery) between the two groups showed no statistical significance, andthe two groups were comparable.2TIMI blood flowwhen the infarct-related artery was opened, TIMI flow grade II or lesswas defined as no reflow. The total incidence of no-flow was25%, it wasconsistent with10~30%reported by statistics. There were7patients in Loadgroup TIMI flow less3grade, accounting for18.4%load group,11patients inthe regular dose group TMPG flow less3grade, accounting for32.3%oftheregular dose group，There were no statistically significant differences in therate of no-flow between Loading dose group and regular dose group (18.4% vs32.3%, P>0.05).3TIMI myocardial perfusion grade(TMPG)There were10patients in load group TMPG flow less3grade, accountingfor26.3%load group,18patients in the regular dose group TMPG flow less3grade, accounting for52.9%of theregular dose group，Compare of twoproportions load group was significantly lower than the regular dose group(26.3%vs52.9%, P<0.05), the difference was statistically significant.4cardiac function evaluation resultstwo groups of patients admitted to BNP levels, load group101±33pg/ml,regular dose group89±45pg/ml, the two groups (101±33pg/ml vs89±45pg/ml, P>0.05), the difference was not statistically significant; BNP levels inthe first postoperative day, the load group275±212pg/ml, regular dose group389±157pg/ml, the two groups (275±212pg/ml vs389±157pg/ml, P<0.05)difference was statistically significant; echocardiography after one month leftventricular ejection fraction (LVEF): load group (54±12)%, significantlybetter than the regular dose group (49±8)%, the two groups the difference wasstatistically significant (P<0.05). Hospitalization and monitoring of liverenzymes and creatine kinase levels during follow-up, no case of severe livertoxicity and muscle toxicity。Conclusion:1The administration of high-dose atorvastatin before emergency PCI inpatients with AMI is benefit to reduce the incidence of no reflow in PCI, andeffectively alleviate the ischemic myocardial perfusion.2Statin loading prior to PCI can reduce injury of ischemia, PCI andmyocardial reperfusion on myocardial, such as the protection of myocardialcell function, improve heart function in patients with AMI.