| Objectives:This study was to investigate the influence of different dose atorvastatin therapy on the carotid intima-media thickness (IMT), incidences of restenosis, the levels of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and high sensitive-C reactive protein (hs-CRP) in the coronary heart disease (CHD) patients after 6 months of PCI , and to assess the correlation between the reduction of IMT and in-stent restenosis after 6 months treatment of different doses of atorvastatin.Methods: One hundred new diagnosised CHD patients including 58 males and 42 females (mean age 58.62±11.25 years old) were enrolled in this study from May 2008 to May 2009, who were diagnosed by coronary angiography (CAG), and received PCI treatment. All patients have no statin therapy 1 month before admission, and no PCI therapy experience. All patients provided written informed consent before enrollment in the study. Exclusion criteria included patients who had histories of statin therapy 1 month before admission, immunological disease, systemic diseases, hepatic injuries, renal injuries, and allergy to statins, clopidogrel, aspirin, heparin, nitrate and contrasts. Women in gestation period and lactation were also excluded. All cases were randomly divided into group A: intensive therapy group with 40mg atorvastatin daily (48) and group B: routine therapy group with 20mg atorvastatin daily (52). All the patients were treated for 6 months.Medcines were administrated to all cases routinly such as aspirin, clopidogrel, heparin, nitrate,β-blockade, and ACEI. Blood samples were collected the day after admission on an empty stomach to examine the levels of HDL-C, LDL-C, hs-CRP as well as alanine aminotransferase (ALT), aspartate aminotransferase (AST) were examined. IMT was measured by ultrasonic within 10 days after admission. CAG was performed in 7-10 days after admission through radialis arteria approach, and the lesions were analyzed by quantitative coronary analysis (QCA). PCI was performed in patients with stenosis of coronary lesion was more than 75% of lumen diameter. The standerd of successful PCI was defined as a postprocedural Thrombolysis In Mycocardial Infarction (TIMI) grade 3 ?ow and a decrease of stenosis to <20% residual narrowing by QCA, and without serious complications. Hepatic enzymology was examined monthly. After 6-month follow-up, levels of HDL-C, LDL-C and hs-CRP, IMT, CAG as well as ALT, AST were re-examined. Basic clinical data, case history, physical examination, laboratory examination and clinical turnover were recorded carefully. Static analysis was taken by spss17.0 for windows. P Values <0.05 (2-tailed) were considered statistically significant.Results: There were no significant statistics difference in age, gender distribution, BMI, abuses of smoking and alcohol, histories of hypertension, diabetes, hyperlipaemia, and drug uses, EF, characteristics of coronary lesions between group A and group B. According to the results of CAG, all cases were divided into single-vessel group, double-vessel group and three-vessel group, and there were significant differences in IMT among the three groups (1.20±0.55 mm vs. 1.57±0.62 mm vs. 2.21±0.87 mm, P<0.05). The IMT increased along with the affection degree of coronary arteries. After 6-month atorvastatin treatment, the result of IMT demonstrated that IMT decreased significantly in both group A and group B (1.54±0.72 mm vs. 1.03±0.50 mm, 1.50±0.70 mm vs. 1.30±0.65 mm, P<0.01, respectively), but the IMT in group A decreased more significantly (1.03±0.50 mm vs. 1.30±0.65 mm, P<0.05). At 6 months followup the results of CAG showed that the incidences of in-stent restenosis was more lower in group A than group B (0 vs. 13.5%, P<0.05). The late lumen lose in group A were significant lower than that in group B (0.272±0.087 mm vs. 0.328±0.068 mm, P<0.01). Correlation analysis showed that there was a negative correlation between the reduction of IMT and incidences of late lumen lose in both group A and group B (r=-0.728, r=-0.530, P<0.01, respectively). But the correlation ship in group A more significantly. The level of LDL-C decreased significantly in both cgroup A and group B (3.55±1.00 mmol/L vs. 1.34±0.51 mmol/L, 3.43±0.93 mmol/L vs. 1.99±0.77 mmol/L, P<0.01 respectively), but the level of LDL-C in group A decreased more significantly (1.34±0.51 mmol/L vs. 1.99±0.77 mmol/L, P<0.01). The level of HDL-C increased significantly in both group A and group B (1.12±0.36 mmol/L vs. 1.48±0.30 mmol/L, 1.14±0.53 mmol/L vs. 1.25±0.51 mmol/L, P<0.05, respectively), but the level of HDL-C in group A increased more significantly (1.48±0.30 mmol/L vs. 1.25±0.51 mmol/L, P<0.01). The level of hs-CRP decreased significantly in both group A and group B (10.20±2.04 mg/L vs. 2.86±0.75 mg/L, 10.25±2.30 mg/L vs. 6.10±1.46 mg/L, P<0.01, respectively), but the level of hs-CRP in group A decreased more significantly (2.86±0.75 mg/L vs. 6.10±1.46 mg/L, P<0.01). But there were no significant increse in ALT in both group A and group B (21.35±9.37 U/L vs. 22.02±8.50 U/L, 21.40±7.82 U/L vs. 21.71±6.77 U/L, P >0.05, respectively), as well as there were no significant increse in AST in both group A and group B (22.23±9.50 U/L vs. 22.93±8.87 U/L,21.85±6.98 U/L vs. 22.46±6.79 U/L, P >0.05, respectively).Conclusions:1 IMT increases with the extent of coronary artery disease. The reduction of IMT can be used to evaluate the in-stent restenosis after PCI therapy.2 IMT decreases more significantly in high dose atorvastatin group than that of routine dose of atorvastatin. There is a significant correlation between IMT reduction and in-stent late lumen lose in high dose atorvastatin group.3 There is more prevention effect to neointimal hyperplasia and in-stent restenosis in high dose atorvastatin group.
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