经皮冠状动脉介入术前常规剂量他汀治疗对围手术期心肌损伤无保护作用

目的 研究择期经皮冠状动脉介入术(percutaneous coronary intervention,PCI)前常规剂量他汀治疗对围手术期心肌损伤的影响.方法 回顾性分析2006年8月至2010年12月于我院心血管内科住院行择期PCI的冠心病患者共293例,根据术前服用他汀与否分为他汀治疗组和非他汀治疗组.于PCI术后20～24小时采集血标本,检测血浆肌钙蛋白I(cTnI)、肌红蛋白(MYO)水平,作为评估围手术期心肌损伤的指标,并观察住院期间主要不良心血管事件.结果 两组患者基线资料基本均衡.他汀治疗组与非他汀治疗组患者PCI术后cTnI升高的发生率分别为22.0％(37/168)与15.2％(19/125),两组患者间差异无统计学意义(P＞0.05)；两组患者PCI术后cTnI升高3倍以上的发生率分别为3.6％(6/168)与4.8％(6/125),组间差异无统计学意义(P＞0.05);PCI术后MYO升高的发生率分别为0.6％(1/168)与2.4％(3/125),两组患者间差异亦无统计学意义(P＞0.05).Logistic回归分析显示,每例患者植入支架数是围手术期心肌梗死唯一的独立预测因子.两组患者住院期间无死亡、心肌梗死、心绞痛复发、紧急血运重建等事件发生.结论 择期PCI前常规剂量他汀治疗并不足以降低围手术期心肌损伤的发生率.需要大规模随机对照研究进一步研究、证实.

Routine dosage of statin therapy before percutaneous coronary intervention has no cardio-protection

Objective This research focuses on the impact of pretreatment with statins of routine dose prior to elective percutaneous coronary intervention（PCI） on periprocedural myocardial injury.Methods From August 2006 to December 2010,293 consecutive patients undergoing elective PCI in our department were retrospectively analyzed,stratified according to the status of preprocedural statin medication.Blood samples were collected 20-24 hours after PCI to test the markers of periprocedural myocardial injury,troponin I（cTnI） and myoglobin（MYO）.Major adverse cardiac events in hospital were recorded.Results The incidences of cTnI elevation were 22.0%（37/168） and 15.2%（19/125） in the statin therapy and no statin therapy group respectively.The rate of cTnI elevation ≥ 3×ULN was 3.6%（6/168） and 4.8%（6/125） in two groups,respectively,the incidence of MYO elevation was 0.6%（1/168） and 2.4%（3/125）,respectively.In the multivariate model,the number of stents deployed per patient was identifed as the only independent predictor of procedure-related myocardial infarction based on postprocedural cTnI elevation ≥ 3×ULN.No major adverse cardiac events took place in two groups during hospitalization.Conclusion Routine dosage of statin therapy before elective PCI seems to be not enough to prevent periprocedural myocardial injury in elective PCI.