The Inflammation In ST-Elevation Myocardial Infarction Patients And Atorvastatin Pretreatment Before Acute Percutaneous Coronary Intervention

Objective The purpose of this study was to probe the differences of levels of inflammatory markers and white blood cell count(WBC) in systemic circulation and infarct-related coronary artery(or narrow coronary artery) in AMI patients and SA patients.Methods This study included 33 patients with STEMI who accepted acute percutaneous coronary intervention(PCI) and 36 patients with SA who accepted selective PCI.Blood samples were obtained from the peripheral vein(V),aortic root(A),and coronary artery(C) respectively in the cardiac catheterization room at the beginning of PCI.Then other sample (V₂₄) was taken from peripheral vein after 24 hours.WBC and all biochemical parameters (IL-6,hs-CRP,MMP-9,and sCD40L) were determined and compared.Results(1) Comparison in group 1) In AMI group,WBC and the levels of IL-6,sCD40L and MMP-9 before PCI were significantly higher in the infarct-related coronary artery(ICA) than in systemic circulation while the coronary level of hs-CRP was lower(all P value＜0.05). WBC and the concentration of IL-6,hs-CRP,sCD40L,and MMP-9 increased after 24 hours (all P value＜0.05).2) In SA group,WBC and the levels of IL-6,hs-CRP,sCD40L and MMP-9 didn't differ in V,A,or C sites(all P value＞0.05),but their systemic levels increased significantly 24h after PCI.(2) Comparison between groups All the levels of inflammatory mediators increased significantly in AMI group compared with SA group,except the ICA level of hs-CRP before PCI(P＜0.05).Conclusions The rupture of atherosclerotic plaque is not only acute systemic inflammatory response,but also the local inflammation with multiply inflammatory markers participating in the site of ruptured plaque. Objective To study the influence of atorvastatin administered to AMI patients before acute PCI on levels of inflammatory markers no matter in systemic circulation or within ICA and ventricular function 7 days after AMI.Methods This study included 60 patients with STEMI who accepted acute PCI.All patients were assigned into atorvastatin group(group A) and control group(group B) randomly.Group A consisted of 32 patients who took 40mg atorvastatin while group B consisted of 28 patients who took placebo.Blood samples were obtained from the peripheral vein and ICA respectively at the beginning of PCI and from peripheral vein after 24 hours.IL-6,MMP-9, sCD40L were determined and compared.The hemodynamic indexes of ventricular function by Acoustic Quantification(AQ) were measured as follow:EDV-LV,ESV-LV,LVEF, PER-LV,and PFR-LV.Results(1) Comparison between two groups:Circulating level of IL-6 decreased significantly in group A compared with group B before PCI.The concentrations of IL-6, sCD40L and MMP-9 in system circulation 24 hours after PCI decreased significantly in group A compared with group B.The data of EDV-LV,ESV-LV,LVEF,PER-LV,and PFR-LV did not did not differ between group A and group B.(2) Comparison in group: The levels of MMP-9,IL-6 and sCD40L were significantly higher in the ICA than in the systemic circulation in two groups.The levels of IL-6 and MMP-9 increased after 24 hours in two groups,but the level of sCD40L of peripheral vein after 24h only increased in controls.Conclusion The levels of MMP-9,IL-6 and sCD40L were significantly higher in ICA than in peripheral vein before acute PCI in STEMI patients.Atorvastatin administered to AMI patients just before PCI could cause lower levels of inflammatory markers,and the early administration of atorvastatin was not more beneficial to ventricular function in short term.