Clinical Study On Cardiac Function And Renal Function Of High-dose Rosuvastatin Therapy In Patients With Acute Coronary Syndromes After PCI

Objective: To evaluate the effect of high-doses rosuvastatin medication on cardiac function and renal function in patients with acute coronary syndrome(ACS)who received percutaneous coronary intervention(PCI). To investigate the predictive values of cystatin C(Cys C)among patients with acute coronary syndrome(ACS).Methods:Patients(n=162)with ACS who received PCI were randomly assigned into rosuvastatin treatment group(40mg loading dose and 5 mg·d-1,n=82)and control group(5 mg·d-1,n=80).Everyone was detected the level of TC, LDL, before treated with rosuvastatin. All patients were accepted based on the clinical situation, including aspirin, clopidogrel hydrogen, tirofiban, low molecular weight heparin, ACEI/ARB, β-blockers, calcium channel blockers, nitric acid esters drugs, diuretics and other basic drugs. Major adverse cardiac events( MACE) were observed during hospitalization, monitoring of adverse drug reactions. Record the heart failure symptoms and signs during the period of hospitalization; Record the situation during the PCI; cystatin c and glomerular filtration rate before PCI and of the second day after PCI were determinated,BNP before PCI and of the fivth day after PCI、LVEF and LVEDd of the fivth day after PCI were determinated,hs-CRP and c Tn I before PCI and of the 12 th hours after PCI were determinate, they were compared between groups. A total of 132 subjects with ACS evidenced by coronary angiography(CAG) were consecutively enrolled, further divided into unstable angina(UA,n=42),non-ST segment elevated myocardial infarction(NSTEMI,n=46)and ST segment elevated myocardial infarction(STEMI,n=44),41 subjects whose CAG results were negative enrolled in case-control group.The clinical data was collected during hospitalization, Cys C was measured as well,all Gensini scores were evaluated.Results: Baseline characteristics were nearly identical in both groups.There was no significant deffience between the two groups of STEMI rate、treatment during PCI and after PCI,there was significant deffience about the STR rate and the TIMI flow of the STEMI between the two groups,treatment group is better than control group;c Tn I of these two groups were same before PCI(1.68±5.31 vs. 1.00±2.48, p =0.3),the treatment group is lower than the control group 12 hour after PCI(22.54±17.78 vs.17.60±13.63,p =0.049); hs-CRP of these two groups were same before PCI(12.66±6.62 vs. 12.93±6.30, p =0.792), the treatment group is lower than the control group 12 hour after PCI(19.89±6.62 vs. 25.07±6.30,p<0.001); BNP of these two groups were same before PCI(145.62±86.34 vs. 146.65±62.30, p =0.931),there was significant deffience about BNP 5 days after PCI between theses two groups(218.34±238.56 vs. 301.55±470.93,p<0.001),the control group is higher; there was significant deffience about LVEF and LVEDd 5 days after PCI between theses two groups,the control is higher of LVEDd,lower of LVEF; there was significant deffience about heart failure symptoms and signs during hospitalization; GFR of these two groups were same before PCI( 105.62±24.07 vs.102.47±23.43, p =0.4), the treatment group is higher than the control group 2 days after PCI(94.14±24.77 vs. 103.40±24.41,p =0.018); Cys C of these two groups were same before PCI(0.98±0.20 vs. 1.00±0.34, p =0.493), the treatment group is lower than the control group 2 days after PCI(1.25±0.34 vs.1.02±0.26,p<0.001);The rate of MACE during hospitalization is lower than control group(χ2=6.956,p =0.008); There is no diffence about adverse drug recation during hospitalization in both two groups(χ2=1.976,p=0.160); There were statistical differences in cystatin C levels in each group( F = 52.732,P <0.001);Positive correlation was detected between Cys C and Gensini score in UA and NSTEMI patients; Logistic regression analysis showed that the factors affecting ACS were elevated Cys C, smoking, advanced age and decreased high-density lipoprotein cholesterol.Conclusion:In real-world clinical practice,high-dose rosuvastatin treatment could significantly decrease the myocardial damage and kidney damage in patients with ACS who received PCI,it will help decreasing the hs-CRP during or after the PCI. Besides, the effect showed no dose dependent.Loading-dose and mild moderate-dose statin,which is relatively safe, could reduce the incidence of MACE during hospitalization. The level of serum Cys C has relationship with the degree of severity in ACS, and it is a risk factor of ACS.