| Objective:To investigate the clinical effect of different dose of atorvastatin and rosuvastatin in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing emergency treatment intervention(PCI).Methods:A total of 220 patients with STEMI were consecutively selected in the Sixth Affiliated Hospital of Guangxi Medical University from July 1 2013 to December 31 2014. All patients received PCI therapy and were divided to 4 groups: Group A: atorvastatin conventional dose group(55 cases), in which patients were given 20 mg of atorvastatin before PCI, and 20 mg / d after PCI; Group B: rosuvastatin conventional dose group(55 cases),in which patients were given 10 mg of rosuvastatin before PCI, 10 mg / d after PCI; Group C: atorvastatin loading dose group(55 cases), in which patients were given 40 mg of atorvastatin before PCI, 40 mg / d after PCI; Group D: rosuvastatin loading dose group(55 cases), in which patients were given 20 mg of rosuvastatin before PCI, 20 mg / d after PCI. The four groups of patients were given the above medication for a month. Quantitative indicators before and after PCI including creatine kinase(CK-MB), cholesterol, alanine aminotransferase(ALT), serum creatinine(Cr), troponin I(c Tn I), high sensitivity C-reactive protein(hs-CRP) and interleukin-6(IL-6), myocardial perfusion were compared among the 4 groups, and major adverse cardiovascular events(MACE) of 4 groups were recorded.Results: 1 General information of the 4 groups including gender, age, time of onset, smoking, hypertension, high cholesterol history, history of diabetes, history of myocardial infarction, family history of coronary heart disease and cardiac function showed insignificant differences(P> 0.05); 2 The prognostic outcome of PCI therapy of 4 groups were evaluated by indicators including vascular disease, interventional number of stents, width and length of stent,the maximum pressure of balloon dilation, surgical intervention time, which showed insignificant differences( P> 0.05); The qualified rate of TIMI TMPG Grade 3 of the two loading dose groups were higher than two conventional dose groups(P <0.05). 3 The cardiac enzyme of 4 groups before PCI, including CK-MB and c Tn I levels,showed insignificant difference(P> 0.05); the CK-MB, c Tn I levels of the 4 groups 24 hours after PCI were higher than the preoperative value(P <0.05); The CK-MB and c Tn I levels among the 4 groups were significant different 24 hours after PCI(P <0.05), the increasing rate in the two loading dose group were higher than the two conventional dose group(P <0.05), and rosuvastatin loading dose group increased less than atorvastatin loading dose group(P <0.05); 4 The hs-CRP and IL-6 Contrast level among the four groups before PCI showed no significant differences(P> 0.05); 24 hours later, the hs-CRP and IL-6 level increased significantly compared with the preoperative value(P <0.05); the comparison between the 4 groups showed significant difference(P <0.05), the hs-CRP, IL-6 level of Group C was significantly lower than Group A and B(P <0.05), and that of Group D was lower than Group A, B and C(P <0.05); seven days later and a month later, the hs-CRP and IL-6 level of each group decreased gradually, and the comparison among the 4 groups showed significant differences: Group B was lower than Group A(P <0.05), Group C lower than Group A and B(P < 0.05), Group D lower than Group A, B and C(P <0.05). 5 The TG, TC, LDL-C, DHL-C level among the 4 groups showed insignificant different before PCI(P> 0.05), but all decreased significantly a month later(P >0.05) and showed significant difference among the 4 groups(P <0.05). The LDL-C level of Group B was lower than Group A(P <0.05), The TC, TG, LDL-C level of Group C were lower while the DHL-C was higher compared with Group A and B(P <0.05), and similarly, the TC, TG, LDL-C level of Group D was lower and the DHL-C level of Group D was higher compared with Group A and B(P <0.05). The TC and LDL-C level of Group D was lower than that of Group C(P <0.05). 6 The preoperative contrast of 4 groups in creatinine(Cr) level showed insignificant difference(P> 0.05). 24 hours after PCI, the Cr level of Group A, B and C increased significantly compare with respective preoperative value(P <0.05). After 24 hours, the Cr level among the 4 groups showed significant differences(P <0.05), in particular, the value of Group C showed significant difference compared with Group A and B(P <0.05), and that of Group D was significantly lower compared with Group A and B(P <0.05); Seven days and one month after the surgery,the Cr level of the 4 groups were closely back to normal, and had no statistically significant difference(P> 0.05). 7 The adverse reactions of drugs including alanine aminotransferase(ALT) ≥3 times, elevated serum creatinine and creatinine value> 2.0mg / dl, rhabdomyolysis, muscle pain, new-onset diabetes, allergies revealed insignificant difference among the 4 groups(P> 0.05). 8 As for the adverse cardiovascular events in the 4 groups after PCI during one month follow-up: six cases in Group A, including three cases of cardiac death, two cases sufferring from myocardial infarction and one case of ischemic stroke; Seven cases in Group B, including three cases of cardiac death, two cases of myocardial infarction and two cases of ischemic stroke; two cases of Group C, including one case of postoperative myocardial infarction, one case of ischemic stroke; two cases in Group D, including one case of cardiac death, and one of ischemic stroke. There were significant differences(P <0.05) among the four groups. Group C showed significant difference compared with Group A and B(P <0.05), and Group D also were significantly different from Group A and B(P <0.05),. However, there were no significant difference between Group C and D.(P> 0.05).Conclusion:1 Conventional dose of rosuvastatin(10mg), compared with conventional dose of atorvastatin(20mg), is better to reduce blood lipids and inflammatory response after primary PCI; 2 loading dose of atorvastatin(40mg) is better to reduce acute myocardial infarction than conventional dose atorvastatin(20mg) and conventional-dose rosuvastatin(10mg) after PCI inflammation; 3 loading dose of rosuvastatin(20mg) is better to reduce blood lipids and acute myocardial infarction than conventional dose atorvastatin(20mg) after PCI inflammation, conventional-dose rosuvastatin(10mg) and the loading-dose atorvastatin(40mg); 4 early application of loading dose statin before PCI and continual use of loading dose of medication(40mg atorvastatin or rosuvastatin 20mg) after PCI in patients with acute myocardial infarction can significantly improve myocardial perfusion and reduce the incidence of postoperative adverse cardiovascular events compared with conventional-dose of medication(20mg atorvastatin or 10 mg rosuvastatin); 5 early application of loading dose statin before PCI and continual use of loading dose of medication(40mg atorvastatin or rosuvastatin 20mg) after PCI in patients with acute myocardial infarction did not significantly increase adverse drug reactions such as liver and kidney dysfunction, myalgia, rhabdomyolysis, compared with conventional dose of medication(20mg atorvastatin or 10 mg rosuvastatin). |
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