经皮冠状动脉介入治疗前应用他汀类药物患者围手术期心肌损伤的meta分析

目的客观评价经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)前他汀类药物治疗对围手术期心肌梗死、术后肌酸激酶同工酶(creatine kinase-MB,CK-MB)和肌钙蛋白(troponin)升高的影响。方法检索PUBMED、EMCC、Highwire数据库及Cochrane图书馆等数据库。检索策略为:(percutaneous coronary intervention,OR PCI)AND(statin OR statins OR hydroxymethylglutaryl-CoA)AND(randomized trial)。入选试验满足条件:随机对照试验,PCI术前应用他汀类药物,试验组为服用他汀类药物的患者,对照组为服用安慰剂、未服用他汀类药物或者服用非大剂量他汀类药物的患者,以围手术期心肌梗死或者CK-MB、肌钙蛋白升高发生率为研究结局。采用比值比(OR)和95%可信区间(CI)作为结果分析的统计量。应用RevMan 5.0以及SAS 9.2软件进行统计分析。结果①术前应用他汀类药物与未应用他汀类药物对比:与未应用他汀类药物比较,PCI术前应用他汀类药物治疗可以降低围手术期心肌梗死的发生率(OR=0.44,95%CI=0.34~0.57,P0.01),术后CK-MB升高的发生率(OR=0.50,95%CI=0.40~0.62,P0.01)以及肌钙蛋白升高的发生率(OR=0.65,95%CI=0.49~0.86,P0.01)。进一步分析发现:只有PCI术前应用大剂量他汀类药物才可以减少围手术期心肌梗死(OR=0.41,95%CI=0.30~0.55,P0.01),术后CK-MB升高(OR=0.43,95%CI=0.33~0.56,P0.01)以及肌钙蛋白升高的发生率(OR=0.57,95%CI=0.46~0.70,P0.01);而非大剂量他汀类药物不能降低围手术期心肌梗死(OR=0.58,95%CI=0.34~0.99,P=0.05)、术后CK-MB升高(OR=0.75,95%CI=0.49~1.14,P0.05)以及肌钙蛋白升高的发生率(OR=0.91,95%CI=0.66~1.26,P0.05)。②术前应用大剂量他汀类药物与应用非大剂量他汀类药物对比:与应用非大剂量他汀类药物对比,PCI术前应用大剂量他汀可以降低围手术期心肌梗死的发生率(OR=0.40,95%CI=0.20~0.79,P0.01),术后CK-MB升高的发生率(OR=0.46,95%CI=0.27~0.76,P0.01)以及肌钙蛋白升高的发生率(OR=0.58,95%CI=0.38~0.88,P=0.01)。结论 PCI术前只有给予大剂量的他汀类药物治疗才可以降低围手术期心肌梗死、以及术后CK-MB和肌钙蛋白升高的发生率。

Effects of statins on periprocedural myocardial injury before percutaneous coronary intervention：a meta-analysis

Objective This meta-analysis was to determine whether statins administration before percutaneous coronary intervention（PCI） can reduce the incidence of periprocedural myocardial infarction, creatine kinase-MB（CK- MB） and troponin elevation after PCI. Methods We searched PUBMED, EMCC, Highwire,Cochrane Library, and the search strategy was or PCI AND （statin or statins or hydroxymethylglutaryl-CoA） and （randomized trial）. The included studies must be randomized controlled trials and they must have a statin therapy group and a placebo or no statin or non-high dose statin control group, the endpoint should be the incidence of periprocedura i myocardial infarction or CK-MB and troponin elevation. Odds Ratios （ OR ） and 95o/oo CI were used to evaluate the effects of statins before PCI on periprocedural myocardial injury. Results @Compared to no statin, statins therapy before PCI reduced the incidence of periprocedural myocardial infarction （ OR = 0.44, 95% CI = 0.34-0.57, P 〈 0.01 ）, CK-MB and troponin elevation after PCI （CK-MB： OR =0.50,95% CI =0.40-0.62, P 〈0.01;troponin.. OR =0.65.95% CI =0.49- 0.86, P d0.01）. And subgroup analysis showed that only high-dose statins pretreatment reduced the incidence of periprocedural myocardial infarction （ OR = 0.41,95 % CI = 0.30-0.55, P 〈 0.01）, CK-MB and troponin elevation after PCI （CK-MB： OR =0.43,95% CI 0.33-0.56, P 〈0.01;troponin： OR =0.57.95%6I =0.46-0.70, P〈 0.01）. But non-high dose statins before PCI did not reduce the incidence of periprocedural myocardial infarction （ OR = 0.58,95% CI =0.34 0.99, P =0.05） ,CK-MB and troponin elevation after PCI （CK-MB.. OR =0.75,95% CI =0.49 1.14, P =0.18;troponin： OR =0.91,95% CI =0.66-1.26, P =0.58）. （Compared to non-high-dose statins,high dose statins pretreatment reduced the incidence of periprocedural myocardial infarction （ OR =0. 42,95 % CI = 0. 20- 0.79, P〈0.01）,CK MB and troponin elevation after PCI （CK-MB： OR = 0. 46, 95 Yoo CI =0.27 0.76, P 〈0.01） troponin： OR =0.58,95% CI =0.38-0.88, P 〈0.01）. Conclusion Only high-dose loading of statins before PCI can reduce the incidence of periprocedural myocardial infarction,CK-MB and troponin elevation after PCI.