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Effects of Loading Dose of Atorvastatin before Percutaneous Coronary Intervention on Periprocedural Myocardial Injury

Author: YuXingLong
Tutor: GeZhiMing
School: Shandong University
Course: Internal Medicine
Keywords: Interventional treatment Myocardial injury Inflammatory response Atorvastatin Major adverse cardiac events
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 45
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Abstract


Objective To investigate the people loading dose of atorvastatin statins with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with selective therapy undergoing percutaneous coronary intervention (PCI), myocardial injury marker serum creatine kinase changes in the working enzyme (CK-MB), of plasma troponin (cTNI) and inflammation markers high-sensitivity C-reactive protein (hs-CRP). And monitoring of serum creatine kinase (CK) and transaminases (ALT / AST), observe the drug due to adverse reactions. Follow-up after 30 days of major adverse cardiac events (MACE) (cardiac death, nonfatal acute myocardial infarction, and target lesion required repeat revascularization) incidence. Objects and methods In this study, 81 patients with NSTE-ACS patients undergoing PCI operation selected in June 2009 October - 2009 Shandong University Qilu Hospital as the research object, are in line with the European Society of Cardiology and cardiovascular disease prevention guidelines and recommendations on diagnostic criteria for NSTE-ACS. Selected cases are within 4 days after the onset of primary PCI. All patients except: 1.ST segment elevation acute myocardial infarction; non-ST-segment elevation acute coronary syndrome in high-risk patients needed emergency coronary angiography; 3 elevated liver aminotransferases (ALT or AST); left room ejection fraction (LVEF) lt; 30%; renal insufficiency (serum creatinine Scr gt; 3mg/dl); the liver or myopathy history; 7. taking statins before admission; 8. coronary angiography required after coronary artery bypass grafting (CABG) patients; 9 after angiography only oral medication. In this study, a prospective, double-blind, randomized, controlled method. 81 patients with NSTE-ACS patients were randomly divided into the the load treatment group and the standard treatment group, the the load treatment group before PCI 12 hours serving Dayton statin 80mg, PCI preoperative two hours chasing Jia Etuo atorvastatin 40mg atorvastatin. All patients in the preoperative and postoperative 8 hours, 24 hours to extract the venous blood plasma CK-MB, cTNI and hs-CRP, CK, ALT / AST. Immunosuppressive Determination of serum creatine kinase isoenzyme (CK-MB) mass concentration, chemiluminescence method troponin Ⅰ (cTNI) concentration; latex-enhanced scattering than the the turbidity determination of ultra-sensitive C-reactive protein (hs -CRP). Monitoring of creatine kinase (CK) and transaminases (ALT / AST), CK-MB, 0-25U / L; cTNI lt; 0.03ug / L; hs-CRP lt; 3mg / L; CK lt; 174U / L; ALT/AST0-40U/L normal. All patients were taking aspirin and clopidogrel 75mg / d at least 5 days before surgery the 6h taking 300 mg of clopidogrel after long-term aspirin taking atorvastatin 20mg clopidogrel 75mg / d for at least 1 years. Recorded higher value of the two groups of markers of myocardial injury; 30-day major adverse cardiac events: sudden cardiac death, nonfatal myocardial infarction, and target lesion revascularization; adverse drug reactions, including gastrointestinal reactions, liver dysfunction, rhabdomyolysis dissolution. Detailed records of clinical baseline characteristics and laboratory test results of the two groups of patients with gender, age, hypertension, diabetes and smoking. SPSS13.0 statistical package for statistical analysis, P lt; 0.05 for the difference was statistically significant. The main statistical indicators are normality test, the normal distribution of the statistical indicators are xs between the two groups were compared using t-test; Pearson-x2 test or count data, Yates-x2 test (correction). Are using a two-sided test, the inspection level α = 0.05. Results 1.PCI patients with abnormal myocardial injury markers and inflammatory response markers elevated in varying degrees, but the the load treatment group, CK-MB, cTNI and hs-CRP level was significantly lower than the standard treatment group (all P lt; 0.01). Major adverse cardiac events: load treatment group occurred accounted for 2.4% vs standard treatment group accounted for 22.5% (P = 0.0161), there is a significant difference, the difference is mainly by a decline in the incidence of myocardial infarction (2.4% vs20.0%; P = 0.0307) constitute. Preoperative atorvastatin absolute risk of statin therapy within 30 days after major adverse cardiac events was significantly reduced by 20.1%. Load treatment group of adverse drug reactions were mild, failed to rhabdomyolysis and other serious adverse phenomenon. The multivariate analysis showed that the load 30 days of treatment group 79.9% reduction in the risk of major adverse cardiac events. (OR = 0.20,95% CI (0.05-0.50); ??p = 0.02). Conclusion NSTE-ACS patients before PCI, a loading dose of atorvastatin can reduce myocardial injury and inflammatory response caused by the PCI, patients with NSTE-ACS. Reduce PCI postoperative adverse cardiac events. Safe and effective.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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