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St-segment Elevation Acute Myocardial Infarction Before PCI, Atorvastatin Treatment Enhanced the Clinical Efficacy

Author: WangKeNi
Tutor: LiuHuiLiang
School: Liaoning Medical
Course: Internal Medicine
Keywords: Atorvastatin Acute myocardial infarction Protease A serum amyloid High-sensitivity C -reactive protein Nitric oxide synthase
CLC: R542.22
Type: Master's thesis
Year: 2011
Downloads: 57
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Abstract


Objective of acute myocardial infarction (Acute myocardialinfarction, AMI) is a common clinical cardiovascular disease, is due to the unstable coronary plaque rupture, intraluminal thrombosis, coronary blood supply occurs drastically reduced or interrupted, so that the corresponding serious and sustained myocardial ischemia leading to myocardial necrosis. Numerous studies show that inflammation in the AM I the occurrence and development plays an important role. Inflammation of coronary plaque instability, rupture, thrombosis of the main factors. Statins have pleiotropic effects in addition to improved endothelial function, plaque stabilization and so anti-inflammatory, anticoagulant, anti-oxidation, lipid external effect. From ARMYDA-1 to ARMYDA-ACS, NAPLES and many clinical trials have shown that regardless of whether the patient before taking statins, PCI preoperative administration of high-dose atorvastatin load treatment, reduced inflammation at the same time, can significantly reduce PCI perioperative incidence of cardiovascular adverse events. This study further explored for ST-segment elevation acute myocardial infarction given preoperatively whether atorvastatin 80mg compared with conventional surgery only given conventional doses 20mg, 40mg reduce or enhance the inflammatory response in patients, reduce infarct size and enhanced atorvastatin therapy security. Methods From May 1, 2010 -2011 on March 31 within 24 hours of onset of consecutive patients who underwent primary PCI for ST-segment elevation acute myocardial infarction, enrolled all patients signed informed consent experiments, according to the random envelope France divided into A, B, C 3 groups, A group (preoperative loading dose of atorvastatin 80mg, after giving atorvastatin 40mg / day); B group (preoperative statin drugs, after giving Atorvastatin 40mg / day); C group (preoperative statin drugs, after giving regular doses of atorvastatin 20mg / day). Determination of indicators: (a) determination of preoperative and postoperative 24 hours, after three days, after 7 days of serum indicators of inflammatory cytokines and endothelial indicators that SAA, hs-CRP and NO synthase. (2) All patients were before surgery, 4 hours, 8 hours, 12 hours, 16 hours, 20 hours, 24 hours, after 36 hours of serum CK, CK-MB. (3) monitoring of patients before surgery, 24 hours, after three days, after 7 days of liver function AST, ALT. (4) monitoring of patients before surgery, 24 hours, after three days, after 7 days of serum lipids TG, CH, LDL-C, HDL-C. (5) Safety assessments included myalgia occur during medication and rhabdomyolysis, statin-induced liver enzymes were increased (more than three times the upper limit of normal to stop the medication, if necessary giving the liver medication), Also included gastrointestinal reactions, such as nausea, abdominal pain, bloating and flatulence, etc. During the test results of 95 cases of AMI patients enrolled, of which 31 cases of group A, B group was 34 cases, C group was 30 cases. 4 cases (A group 1, B group 2, C group 1) due to intraoperative or postoperative deaths, five cases (A group of two people, B group 1, C group 2) As postoperative transaminase more than three times the experiment is terminated. (A) three groups of patients when the disease situation and the general baseline data, the difference was not significant, comparable. (2) three groups of patients with postoperative level of SAA comparison: A group of 24 hours after the level of SAA 11.9 ± 4.54, B group SAA levels of 15.72 ± 6.52, C group SAA levels of 18.15 ± 4.22, pairwise comparisons among the three groups was not statistically difference (P gt; 0.05). After three days of group A level of SAA 12.8 ± 5.97, B group level of SAA 18.15 ± 4.22, C group level of SAA 18.23 ± 7.0; A than in group B group, A group SAA lower level than the C group difference was statistically significant (P < 0.05); B group compared with C group had no significant difference (P gt; 0.05). 7 days after Group A level of SAA 7.31 ± 3.61, B group level of SAA 10.13 ± 5.13, C group level of SAA 12.86 ± 4.98, three groups were compared statistically significant, P <0.05; A than in group B group, A group representing SAA levels in group C was significantly (P <0.05); B group compared with C group showed no significant difference (P gt; 0.05). (3) three groups of patients of HS-CRP level comparison: after 24 hours of group A HS-CRP levels of 7.41 ± 2.34, B group HS-CRP levels of 7.81 ± 4.27, C group HS-CRP levels of 8.58 ± 3.99, three Comparison between two groups was no significant difference (P gt; 0.05). After three days of group A HS-CRP levels 8.67 ± 2.55, B group HS-CRP levels 10.74 ± 3.89, C group HS-CRP levels 13.55 ± 5.10, three groups were compared statistically significant, P <0.05; A group than group B, A group compared with C group HS-CRP levels decreased, the difference was statistically significant (P <0.05); B group compared with C group had no significant difference (P gt; 0.05). 7 days after Group A HS-CRP levels 5.64 ± 1.55, B group HS-CRP levels of 8.36 ± 2.32, C group HS-CRP levels of 7.66 ± 2.53, three groups were compared statistically significant, P <0.05; A group than group B, A group compared with C group after HS-CRP levels decreased significantly (P <0.05); B group compared with C group showed no significant difference (P gt; 0.05). (4) NO synthase in three groups of patients were compared: group A, 24 hours after NO synthase 3.19 ± 0.52, B of NO synthase 2.86 ± 0.67, C group NO synthase 2.93 ± 0.422, among the three groups no significant difference pairwise comparisons (P gt; 0.05). After three days of group A NO synthase 3.29 ± 0.42, B of NO synthase 2.95 ± 0.65, C group NO synthase 2.96 ± 0.48, pairwise comparisons among the three groups was no significant difference (P gt; 0.05) . A group of 7 days after NO synthase 3.68 ± 0.54, B levels of NO synthase 3.22 ± 0.98, C level of NO synthase 2.99 ± 0.52, three groups were compared statistically significant, P <0.05; A group than group B, A group compared with C group were elevated levels of NO synthase significantly (P <0.05); B group compared with C group showed no significant difference (P gt; 0.05). (5) CK compared three groups of patients: patients in group A peak CK 2828 ± 1055.6, B postoperative peak CK 3906. ± 1873.76, C group after peak 3934. ± 2415.10, three with significant difference between the two groups , P <0.05; A postoperative peak CK was significantly lower than in group B was significantly (P <0.05), A postoperative peak CK was significantly lower than in group C was significantly (P <0.05), B group and C group were no significant difference between peak CK (P gt; 0.05). (6) three groups of patients CK-MB comparison: A group of postoperative peak 233.9 ± 102.71, B postoperative peak 319.40 ± 111.104, C group after the peak 373.6 ± 174.87, three with significant difference between the two groups, P <0.05; A postoperative CK-MB peak was significantly lower than group B, the difference was statistically significant (P <0.05), A postoperative CK-MB peak was significantly lower than C group difference was statistically significant (P <0.05) , B and C group postoperative CK-MB was no significant difference between the peak (P gt; 0.05). (7) three groups of patients TG, CH, LDL-C, HDL-C compared: group A, 24 hours after TG levels 1.83 ± 0.66; B group TG levels 1.82 ± 0.53; C group TG levels 1.86 ± 0.73, three groups of patients after 24 hours pairwise comparisons TG levels was no significant difference (P gt; 0.05). After three days of group A TG levels 1.68 ± 0.51; B group TG levels 1.75 ± 0.58; C group TG levels 1.74 ± 0.67, three groups of patients after three days pairwise comparisons TG levels was no significant difference (P gt; 0.05) . 7 days after TG levels in group A, 1.66 ± 0.51; B group TG levels 1.67 ± 0.69; C group TG levels 1.73 ± 0.49 three groups of patients after 7 days TG levels was no significant difference (P gt; 0.05) after 24 A group of CH-hour level 5.36 ± 0.97; B group CH level 5.19 ± 1.07; C group CH level 5.12 ± 1.67, three groups of patients after 24 hours CH level pairwise comparisons no significant difference (P gt; 0.05). A group of CH 3 days after the level of 4.53 ± 0.62; B group CH level 4.94 ± 1.08; C group CH level 5.00 ± 1.37, three groups of patients after 3 days CH level pairwise comparisons no significant difference (P gt; 0.05) . 7 days after Group A CH level 4.10 ± 0.58; B group CH level 4.61 ± 0.93; C group CH level 4.94 ± 1.11, A group than in group B, A group CH lower level than the C group difference was statistically significant (P < 0.05), B group compared with C group showed no significant difference (P gt; 0.05). A group of 24 hours after LDL-C level 2.90 ± 0.37; B group, LDL-C level 3.15 ± 0.68; C group, LDL-C level 3.07 ± 0.76, three groups of patients after 24 hours LDL-C level was not statistically pairwise comparison Learn the difference (P gt; 0.05). 3 days after LDL-C levels in group A 2.80 ± 0.64; B group, LDL-C level 3.06 ± 0.68; C group LDL-C level 3.13 ± 0.75, three groups of patients after three days LDL-C level was not statistically pairwise comparison Learn the difference (P gt; 0.05). A group of 7 days after LDL-C level 2.32 ± 0.63; B group, LDL-C-level 2.73 ± 0.67; C group, LDL-C level 2.96 ± 0.76, three groups were compared statistically significant, P <0.05; A group than in group B, A group compared with C group LDL-C levels lower, the difference was statistically significant (P <0.05), B group compared with C group showed no significant difference (P gt; 0.05). A group of 24 hours after the HDL-C level 1.97 ± 0.93; B group, HDL-C level 1.91 ± 0.89; C group HDL-CC levels of 1.96 ± 0.80, three groups of patients after 24 hours HDL-C levels was not statistically pairwise comparison Learn the difference (P gt; 0.05). After three days of group A HDL-C level 1.81 ± 0.89; B group, HDL-C level 1.86 ± 0.79; C group, HDL-C levels 1.91 ± 0.78, three groups of patients after three days HDL-C levels was not statistically pairwise comparison Learn the difference (P gt; 0.05). 7 days after HDL-C levels in group A 1.88 ± 0.82; B group, HDL-C level 1.83 ± 0.76; C group HDL-C level 1.82 ± 0.72 three groups of patients after 7 days HDL-C levels showed no significant difference ( P gt; 0.05). (8) Monitoring three groups of patients AST, ALT levels: group A, 24 hours after ALT level 96.3 ± 146.03; B group ALT level 99.7 ± 121.71; C serum ALT level 132. ± 154.29, three groups of patients with ALT levels after 24 hours no significant difference pairwise comparisons (P gt; 0.05). 3 days after ALT levels in group A 89.50 ± 55.11; B group ALT level 112.3 ± 91.22; C serum ALT levels 102.2 ± 70.49, three groups of patients ALT levels after three days pairwise comparisons no significant difference (P gt; 0.05) . 7 days after ALT levels in group A 64.06 ± 29.81; B group ALT levels 52.15 ± 12.38; C serum ALT levels 56.24 ± 27.00, three groups of patients ALT levels after 7 days no significant difference pairwise comparisons (P gt; 0.05) . AST compared three groups of patients: patients with AST levels surgery three groups no significant difference between any two, comparable (P gt; 0.05). A group of 24 hours after AST levels 67.5 ± 32.67; B group AST levels 80.75 ± 26.43; C group AST levels 77.19 ± 29.50, three groups of patients after 24 hours AST levels pairwise comparisons no significant difference (P gt; 0.05) . After three days of group A AST levels 57.90 ± 26.12; B group AST levels 67.15 ± 23.58; C group AST levels 63.33 ± 19.43, three groups of patients ALT levels after three days pairwise comparisons no significant difference (P gt; 0.05) . A group of 7 days after AST levels 49.99 ± 20.67; B group AST levels 48.45 ± 12.86; C group AST levels 52.95 ± 18.10 three groups of patients after 7 days AST levels showed no significant difference (P gt; 0.05). Conclusions In this study, for patients with acute ST-segment elevation myocardial infarction in patients given before primary PCI 80mg, after successive give 40mg / day atorvastatin drug intervention, and only after strengthening dose 40mg / day, regular dose 20mg / Day comparison found that: (1) acute myocardial infarction, preoperative administration of 80mg atorvastatin, after giving 40mg / day atorvastatin treatment modalities can significantly reduce emergency PCI perioperative inflammation levels. (2) acute myocardial infarction, preoperative administration of atorvastatin 80mg, after giving 40mg / day atorvastatin treatment model can significantly improve emergency PCI perioperative vascular endothelial function. (3) given preoperatively in acute myocardial infarction 80mg atorvastatin, after giving 40mg / day atorvastatin therapy mode reduces emergency PCI perioperative serum CK, CK-MB peak, presumably to reduce myocardial infarct size have a certain effect. (4) given preoperatively in acute myocardial infarction 80mg atorvastatin, after giving 40mg / day atorvastatin treatment modalities in the emergency PCI perioperative liver function had no significant effect.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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