Effects Of Diffenent-doses Lipitor On Inflammatory Markers Of Patients With Acute Coronary Syndromes After Percutaneous Coronary Intervention

BackgroundRandomized studies have shown that pretreatment with atorvastatin may reduce periprocedural myocardial infarction and improve outcomes in patients with ACS undergoing early invasive stratry.It was believed,for the most part,that benefit of atorvastatin was due to the lowering of LDL-C levels, However, the other molecular mechanism remained to be rarely investigated.ObjectiveThe purpose of the study was to investigate whether atorvastatin affected serum levels of inflammatory markers, focusing on C-reative protein (CRP),Soluble CD40 ligand (sCD40L),and matrix metalloproteinases-9 (MMP-9), which might help to explain the molecular mechanism except for lipid-lowering.MethodsA total of 60 patients with ACS undergoing early invasive stratry were randomized to pretreatment with atorvastatin (20mg 12h before PCI,40mg 12h before PCI,60mg 12h before PCI ). Blood samples were collected before and at 8 and 24 h after PCI to measure creatine kinase-MB,troponin-I and The serum levels of CRP,sCD40L and MMP-9 by ELISA.All patients were given a clopidogrel and aspirin 300-mg loading dose.All patients received long-term atorvastatin treatment thereafter (20mg/day).The main end point of the trial was a 30-day incidence of major adverse cardiac events (death,myocardial,or unplanned revascularization).ResultsThe serum levels of CK-MB,TnI,CRP,sCD40L and MMP-9 were all higher in ST-segment acute mgocardial infarction patients than in unstable angina pectoris and non-ST-segment acute mgocardial infarction patients. Serum CRP,MMP-9 and sCD40L levels were significantly lower in the 60mg atorvastatin arm than in the 20mg and 40mg atorvastatin arm at baseline. Such a decrease was most significant in 24 h after PCI. The differences of serum inflammatoryfactor levels did not change after covariate analysis (taking into account the number of drug treated stents and high-density lipoprotein cholesterol).Liner regression analysis showed TnI levels were positively correlated with MMP-9. The primary end point occurred in 10% of patients in the 20mg atorvastatin arm,0% of patients in the 40mg atorvastatin arm and 0% of patients in the 60mg atorvastatin arm.ConclusionsThe increasing of Serum levels of CRP,sCD40L,and MMP-9 may be mediated the inflammatory process in patients with ACS,which correlated with the extent of patient's condition.In addition,The trial indicates that even short-term pretreatment with atorvastatin may alleviate serum levels of CRP,sCD40L,and MMP-9 in patients with ACS undergoing early invasive strategy. Such a decrease was most significant in 24 h after PCI. which,at least in part,explain the protective role of atorvastatin.