The Study Of Usage Of Statins In CHD Patients Post PCI Fellow-up

Objective: In recent twenty years ,the morbility and mortality of CHD have been rised guadually. and CHD has been known a disease associated with lipid metabolism and endothelial function. A role for inflammation has become well established over the past decade or more in theories describing the atherosclerotic disease process .and statins have been known as the most important role to treat CHD for lipid lowing ,antiflammation, antithrombotic effct and improving endothelial function after the 4S study. Although a notable improvement has been seen in PCI ,but the application of endovascular stent can cause in-stent restenosis can't prevent causing new coronary artery obstruction. so CHD patients had also been prescribed with statins ,aspilin and other medicine undergoing PCI. Recently the study of statins focus on how to improve the success rate of hypercholesterolaemia and low the side effct .Yet the data of usage of statins are poor in our country. The aim of this study was to assess the safety and effects of different dose of statins on serum lipids, inflammatory markers and clinical events in CHD patients post PCI. we compare hs-CRP and white blood cell count to predict inflammatory in patients undergoing percutaneous coronary intervention . We also registered CHD patients post PCI and discuss how to improve the usage of stains.Methods: (1) A total of 124 patients with CHD post successful PCI were randomly divided into atorvastatin 10 mg/d(group A), atorvastatin 20 mg/d(group B) ,simvastatin 20 mg/d(group C) and simvastatin 40 mg/d(group D).Blood were taken at baseline and 7-10 days for serum alanine aminotransterase (ALT),lipids,high-sensitive C-reactive protein (hs-CRP) and leukocyte count .The major adverse cardiac events (MACE)were also observed . (2) comparison of hs-CRP and WBC count were analysed by the one way analysis of variance (ANOVA). (3)A total of 663 patients with CHD post successful PCI were registered in our hospital from the June 2006 to the February 2007 .and fellow-up was taken in a month and half a year after using statins by telephone and face to face. The data including the reasonas why the patents stopped statins or changed statins and discuss the reasons at last.Results: (1) Four treatment groups decreased from baseline in TC and LDL-c levels,But they had no significant difference with each other. There was no significant difference among statin regimens on hs-CRP levels at 7-10 days. but the level of hs-CRP decreased in the patients with high cardiovascular risk ,while the level of hs-CRP elevated in the low-risk patients .All four groups of patients had the same safety. (2) In stable CAD group hs-CRP and WBC count were elevated after procedure(P<0.0001).Hs-CRP and WBC count have no statistically difference in unstable CAD group(P=0.117,P=0.596). In AMI group hs-CRP decreased (P=0.013) while WBC count had no statistically difference(P=0.16) after procedure. Hs-CRP was showed to correlate positively with WBC count at baseline in AMI group but had no correlation after using statins. (3) The rate of CHD patients post PCI changed and stopped statins were high. About 60.2% patients had still usinig statins in a month post PCI. But decented to 23.5% in half a year. The main reasons why the patients changed or stopped statins in a month was the patients were in poor economic conditions and feared the serious side effect about statins .Some patients thought they were in health condition and need not to be prescribed statins any more. While the reasons in half a year was the patients were in poor economic conditions and physicians didn't prescribe statins according guideline.Conclusions: (1)The usual dose of two statins is safe to patients post PCI in our country .but lipid lowing effct is more strong than west countries and More hepatotoxicity is seen in China. Whether lillte dose of statins will be prescribed to the patients are very sensitive to statins need further discussion. (2)Among patients undergoing PCI statin can reduce the inflammationary markers such as hs-CRP and WBC count. Hs-CRP and WBC count decreased greater in patients with higher cardiovascular risk. Hs-CRP is more sensititive than WBC count as an inflammationary marker. (3) The usage of statins in patients post PCI are not satisfied. The economic condition is very important to insist using statins. and the suggestion given by physicians has the determined effct in patients insisted using statins.