Clinical Study Of Percutaneous Coronary Intervention In Myocardial Injury And Perioperative Intensive Statin Management

Part One:Research of Percutaneous Coronary Intervention-related Myocardial InjuryBackground:Cardiac troponin-I (cTnI) and-T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial.Objective:In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population.Methods:with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI.Results:A total of1,008patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed-up by26±9months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the99th percentile upper reference limit (URL) in133(13.2%) patients, among which22(2.2%) were more than5×99th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR1.35(P=0.33,95%CI:0.74-2.46).Conclusion:In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs. Part Two:A Correlation between Acute Kidney Injury and Myonecrosis after Scheduled Percutaneous Coronary InterventionBackground:Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary intervention (PCI). Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome induced by exposure to intravascular contrast media (CM). Currently, the relationships between the contrast medium, pre-existing kidney insufficiency, CI-AKI and myonecrosis after elective PCI are unclear.Objective:To investigate the relationship between CI-AKI and post-procedural myonecrosis (PMN) after PCI.Methods:non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. The levels of cTnI and cTnT (cTns) at baseline and on at least one occasion18-24h after PCI were measured. We also recorded serum levels of creatinine (SCr) and ACR (defined as the urine albumin:creatinine ratio) before coronary angiography, and24-48h and48-72h after contrast administration.Results:We analyzed327non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. A post-procedure increase in cTns was detected in16.21%(53/327) of subjects with cTns levels>99th to5×99th percentile URL. Twenty-seven patients (8.26%) developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN (20.8%versus5.8%, respectively, P=0.001). Multiple logistic regression analysis revealed that pre-existing microalbuminuria (MA) was an important independent predictor of PMN (OR:3.31;95%CI:1.26-8.65, P=0.01). However, there was no correlation between the incidence of CI-AKI and PMN, P=0.09(OR:2.38;95%CI:0.88-6.46).Conclusion:We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN. Part Three:Efficacy of intensive AtorvaStatin Treatment On the Post-PCI Myocardial Injury and Short-Term Prognosis of the Angina Pectoris PatientsBackground:Peri-procedural myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI.Objective:To observe different doses of intensive and maintenance atorvastatin on major adverse cardiovascular events on angina pectoris patients in the perioperative period of PCI.Methods:CAD patients were randomly divided into three groups, group intensive80mg, group80+40mg and group control. The levels of CK-MB and cTnT were measured before,12h and24h after PCI. PCI-related myocardial infarction is defined as troponin increased5-fold99%of the upper limit of normal compared with baseline or accompanied by chest pain or EKG ST-T changes.Results:After PCI, control group CK-MB>5times the upper limit of normal reference values (5UNL) is2.0%, P=0.52, and no intensive group patients over five times, cTnT>5UNL is6.0%, while intensive80+40mg group>5UNL is2.7%, P=0.50. There was no statistical difference among groups. After PCI, serum low-density lipoprotein cholesterol (LDL-C) were significantly decreased when compared with the level of baseline, but there was not statistically significant among groups; the level of serum Hs-CRP and Fib were elevated compared with the control group, but there was not statistically significant among groups.Conclusion:For the angina pectoris patients, the enhanced atorvastatins in the perioperative period of PCI would further reduce the rates of myocardial infarction. But, there was no statistically significant when compared with conventional treatment.