Effect And Safety Of Different Doses Of Statin Use In Patients Undergoing CABG Surgery

Objective: To evaluate the effect of different doses of statins therapy in patients with peri coronary artery bypass grafting(CABG) on serum markers of myocardial injury,hs-CRP,adverse cardiac events, and analyze the safety of the drug.Methods: 78 off-pump CABG patients were randomly divided into observation group(40 cases)and control group(38 cases), observation group took 40 mg atorvastatin 12 hours before and once a day during 30 days after operation; control group took 10 mg atorvastatin per day before and during 30 days after operation herein. To observe the change of Troponin I(c Tn I) and creatine kinase MB isoenzyme(CK-MB)before and 6h, 12 h after CABG and serum high sensivity C-reactive protein(hs-CRP) before and 1d, 7d, 14 d and 30 ds after CABG,and compare their lipids and liver and kidney function. After one month of treatment, to evaluat the efficacy ?adverse cardiac events recorded and drug adverse reactions,of high-dose atorvastatin therapy in the peri CABG and low-dose atorvastatin treatment group compared.Results: By evaluating the effect of different doses of statins therapy in patients with CABG on serum markers of myocardial injury, we found that the levels of c Tn I,CK-MB were significantly increased compared with preoperation in both groups of patients, furthermore the increasing was more obvious in control group. The details are as follows:(1) The levels of c Tn I,CK-MB, hs-CRP before CABG were similar in two groups of patients, difference was not statistically significant(t=0.590,0.331,0.363,p>0.05); Post CABG, c Tn I,CK-MB, hs-CRP levels were significantly increased compared with preoperation in both groups of patients, difference within the group was statistically significant(F=5.056,4.885,8.120,p<0.05); between two groups, increasing was more obvious in control group; and c Tn I,CK-MB, hs-CRP levels in observation group were lower than control group, the difference was statistically significant(t=1.852~22.944,p<0.05).(2) The levels of T-CHO,LDL-C before CABG were similar in two groups of patients, difference was not statistically significant(t=0.344,0.313,p>0.05,p>0.05); Post CABG, T-CHO,LDL-C levels were significantly descreased compared with preoperation in both groups of patients, difference within the group was statistically significant(F=6.013,7.256,p<0.05); between two groups, descreasing was more obvious in control group; and T-CHO,LDL-C levels in observation group were higher than control group, the difference was statistically significant(t=3.270~23.314, p<0.05).(3) Mild-increasing of ALT was found in every group, none of them exceeded 3 times the upper limit, and no patients withdrew.(4)The incidence of gastrointestinal discormfort, blood Cr increasing are similar between two groups and there was no severe adverse effects as significant renal impairment or myopathy.(5) During the 4-week follow-up, some patients occurred major adeverse cardiac events(MACE), both in the observation group and in the control group, but p>0.05.Conclusions:(1) High-dose statin therapy in peri CABG can reduce the inflammatory markers levels and myocardial injury.(2) Peri CABG 40 mg atorvastatin reduce the incidence of adverse cardiac events due to the reduction of CABG related myocardial injury and CABG-related myocardial infarction.(3) Short-term intensive therapy of 40 mg atorvastatin perday was safe, suggesting using in patients undergoing CABG surgery.