The Myocardial Protection Effect Of High-Dose Atorvastatin Pretreatment Before Percutaneous Coronary Intervention In Acute Coronary Syndrome

Objective:To observe the change of soluble CD40 ligand (sCD40L), highly sensitive C-reactive protein (hs-CRP) in preoperative and postoperative,and investigate the myocardial protection effect of a single high-dose (80mg) atorvastatin intensive treatment before percutaneous coronary intervention(PCI) in acute coronary syndrome (ACS) patients with the conventional atorvastatin (20mg/qn).Methods:The day before PCI,60 ACS patients were randomly divided into control group (atorvastatin 20mg/qn, n=30) and intensive group (atorvastatin 80mg12h before PCI, n=30). sCD40L, hs-CRP, creatine kinase-myocardial isoenzyme (CK-MB), car-diac troponin I (cTnI) were assessed before and 24 and 48h after PCI. The incidence of perioperative myocardial infarction (MI) and major adverse cardiac events(MACEs) were compared during 30-day follow-up.Results:(1)The sCD40L level was not statistically significant (P>0.05) on 24 and 48h after PCI in intensive treatment group.In the control group, the sCD40L level elevated 24h after PCI(1649.00±1031.75 vs 1220.00±756.91, P<0.01, but there was no significant difference 48h after PCI 1087.92±603.81 vs1220.00±756.91, P>0.05). (2) There was significant difference about the hs-CRP level between preoperative and postoperative in two groups (P<0.001).The elevation degree of hs-CRP in the intensive group was significanily lower compared with control group (4.80 vs 8.03, P<0.05). (3) 24h after PCI the levels of cTnI,CK-MB were significantly higher than preoperative (P<0.001).The cTnI and sD40L (r=0.313, P=0.023),cTnI and hs-CRP (r=0.288, P=0.033) had positive correlation perspectively. The CK-MB and sD40L (r=0.421,P=0.001),CK-MB and hs-CRP (r=0.283, P=0.030) had positive correlation perspectively. (4)The incidence of cTnI elevation> 3xupper limit of normal(ULN) was 3.33%(1 of 30) in intensive group and 10.00%(3 of 30) in control group. The incidence of CK-MB elevation>3xULN was 6.67%(2 of 30) in intensive groups and 10.00%(3 of 30) in control group. (p>0.05).(5)There were no changes of AST, ALT, Cr, CK before and after treatment in two groups.(6)There were no MACEs in 30-day follow-up.Conlusions:(1)The inflammation and platelet activation caused by PCI,preoperative strengthen preventive anti-inflammatory and anti-platelet therapy should be given; (2) PCI may cause myocardial injury, and which was related to the inflammation and platelet activation. (3)For the ACS patients who accepted regular atorvastatins treat-ment, high-dose (80mg) atorvastatin 12h before PCI has the effect on decreasing the level of sCD40L,hs-CRP,and reduce the incidence of periprocedural MI. (4)On the base of conventional atorvastatin treatment, preoperative 80mg atorvastatin intensive treatment didn't show adverse effect.