摘要
目的探讨冠状动脉介入治疗(PCI)术前超短期应用他汀类药物对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者心肌再灌注及短期预后的影响。方法将入院后72h内接受PCI的162例NSTE-ACS高危患者随机分为强化他汀治疗组和标准剂量他汀治疗组,于PCI术前服用辛伐他汀3d,观察PCI术前、术后即刻靶血管心肌梗死溶栓试验(TIMI)血流分级和心肌呈色分级(MBG)的差异,以及PCI术后24h肌酸激酶同工酶(CK-MB)的变化、PCI术后1个月心功能和主要心脏不良事件(MACE)的发生情况。结果两组间基础临床资料比较差异无统计学意义(P<0.05)。PCI术前强化组靶血管TIMI血流2～3级和MBG2～3级的比例显著高于标准组,差异有统计学意义(P<0.05)。PCI术后两组靶血管TIMI血流3级比例差异无统计学意义(P>0.05),强化组靶血管MBG2～3级的比例显著高于标准组,差异有统计学意义(P<0.05)。强化组CK-MB增高比例显著低于标准组,差异有统计学意义(P<0.05)。PCI术后1个月强化组左心射血分数(LVEF)为(0.58±0.09)%,明显好于标准组(0.53±0.08)%,差异有统计学意义(P<0.05)。强化组MACE发生率明显低于标准组,差异有统计学意义(P<0.05)。结论超短期大剂量服用他汀可明显改善NSTE-ACS高危患者PCI术后冠脉血流、心肌灌注和心功能,减少MACE的发生率。
Objective To evaluate the effect of short - term pre - treatment with statins on the reperfusion and short - term clinical prognosis in patients with non ST - segment elevation acute coronary syndrome （ NSTE - ACS） who underwent successful primary percutanous coronary intervention （PCI） . Methods A total of 162 consecutive high - risk NSTE - ACS patients undergoing PCI within 72 hours were randomly divided into two groups： standard statin group received 20 mg simvastatin and intensive statin group received 80 mg simvastatin for 3 days before PCI. The difference of thrombolysis in myocardial infarction （TI- MI） and myocardial blush grade （MBG） of target arteries before and after PCI, serum level of CK - MB at 24h, left ventricular ejection fraction （LVEF） and the incidence of main adverse cardiac events （MACE） at 30 -day follow -up were examined in the 2 groups. Results The difference in basic clinical data between the two groups showed no statistical significance （ P 〈0. 05 ）. The percentage of TIMI grade 2 - 3 flow and MBG 2 - 3 perfusion were significantly higher in intensive statin group than those in standard statin group before PCI （ P 〈 0. 05 ）. The TIMI grade 3 flow in intensive statin group showed similar result to that in standard statin group after PCI （P 〉 0. 05 ）, but the percentage of MBG 2 - 3 perfusion in intensive statin group was significantly higher than that in standard statin group （P 〈 0. 05 ）. The incidence of increased CK - MB in intensive statin group was significandy lower than that in standard statin group （P 〈0.05）. One month after PCI the LVEF in intensive statin group [ （0. 58 ± 0. 09 ） % ] was higher than that in standard statin group [ （0. 53 ± 0. 08 ） % ] （ P 〈 0. 05 ）. The incidence of MACE （ P 〈 0. 05 ） in intensive statin group was also lower than that in standard statin group. Conclusion Pre - treatment with short - term statin of high - dose before PCI could improve the PCI postoperative coronary flow, myocardial perfusion and heart function, attenuate the risk of MACE in high - risk NSTE - ACS patients.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第1期49-51,共3页
Chinese General Practice
