The Application Research Of High-dose Atorvastatin To Acute Myocardial Infarction Patients During Percutaneous Coronary Artery Interventional Therapy A Randomized Controlled Clinical Research About Chinese People

Objective To assess high-dose atorvastatin used in patients with acute st-elevationmyocardial infarction(STEMI)with primary percutaneous coronary intervention(PPCI)with close, long-term prognosis and the impact of adverse reactions, to optimize thepatients with acute st-elevation myocardial infarction perioperative regimen.Method Consecutive selected a total of120cases with STEMI in our hospital fromJune2010to November2012.All selected cases received PPCI therapy.120selected caseswere divied to two groups by random principle:atorvastatin20mg/d group (20mgatorvastatin was given before PPCI,20mg/d after the PCI,n=60) or40mg/d group (given80mg atorvastatin before PPCI in emergency,40mg/d after PCI,then,20mg/d the firstmonth after PCI,n=60).After the operation each group was compared thrombolysis inmyocardial infarction(TIMI) flow grade,TIMI myocardial perfusion(TMP) grade,corrected TIMI frame (CTFC),70%ST segment drop after two hours.Quantitativeindicators of myocardial infarction，Indices of blood biochemistry, N-terminal pro-brainatriuretic peptide(NT-proBNP), Compared Creatine kinase isoenzyme (CK-MB),troponin I(cTnI),high sensitivity C-reactive protein(hs-CRP) peak and the peak time, the change ofplasma cholesterol,the influence of Liver and kidney function, recurrence of myocardialinfarction and death during hospitalization et al.Follow-up of patients,record the rate ofmajor adverse cardiovascular events (MACE),the result of cardiac ultrasonography and thelevel of plasma cholesterol,N-terminal pro-brain atriuretic peptide(NT-proBNP), Liver andkidney function,creatine kinase(CK).Carrie on the statistical analysis of relevant data.Result1.Compared with the20mg group,the40mg group blood perfusion of TIMI3level immediately postoperative and the proportion of patients with myocardial perfusion grade TMP3were significantly increased(P<0.05);the proportion of patients withno-reflow and the proportion of patients with TMP0-1reduced were significantlyreduced,but it has no statistical significance(P<0.05).CTFC cout in40mg groupsignificantly reduced(P<0.05),the proportion of patients with70%ST segment declinedafter2hours in the high dose significantly increased(P<0.05),in hospitalization CK-MBand cTnI peak significantly reduced (P<0.05),three of their peak time was significantlyahead of schedule(P<0.05).2.Compared with the20mg group,the level of hs-CRP and NT-proBNP wassignificantly lower in the40mg group in12h,3d,7d,4w,12w,24w,48w after PCI(P<0.05).the level of hs-CRP and NT-proBNP showed a trend of gradual decline after peakin both of the two groups.3.Compared with the20mg group, the level of LDL-C was significantly lower in the40mg group in4w,12w,24w,48w after the operation(P<0.05), the level of LDL-C showed atrend of gradual decline after peak in both of the two groups,makes it easier reach thestandard,but it has no statistical significance(P<0.05).The lever of HDL-C showed a trendof gradual increase.4.The level of Cr had no significantly difference before or after the operation.Dynamic analysis showed,the level of Cr increased in12h to3days after the operation, asfollow-up it gradually declined to the normal.There were two patients with radiographiccontrast nephropathy in the20mg group while was no one in the40mg group,it had Nostatistical significance.5.Compared with the20mg group,parameters of left ventricular function in patients of40mg group were significantly better in1month,6months and12months(P<0.05),WMSI,LEVSVI,LEVDVI were all significantly lower than20mg group(P<0.05).2.6.The proportion of patients with ALT rose less than3times was significantlyhigher during hospitalization in40mg group(P<0.05).Three patients in the high-dose ALTrose more than three times,stopped statin therapy,and given liver protectivetreatment,while there is one patient stopped statin therapy in regular-dose group.Meanwhile the proportion of patients with CK rose about one times significantly higher inthe high-dose group,but on patient stopped statin therapy in both of the groups.The levelof ALT and CK had no significantly differene in4w,12w,24w,48w after PCI in both of thegroups.Statins therapy did not have adverse influence with the fasting blood-glucose,as one year follow-up,there is no new-onset diabetes.7.Follow-up1month,6month and12month,compared with20mg group,MACE wassignificantly reduced in40mg group(P<0.05),Use of Kaplan-Meier method to calculatetwo groups of patients cumulative survival rate. The no MACE MS group was alsosignificantly lower (P<0.05).Conclusion Given80mg atorvastatin therapy before PPCI in patients with STEMIbefore PPCI in emergency,40mg/d during the first month after PPCI could increase thelevel of myocardial perfusion immediately after surgery,inhibit the inflammatoryresponse,improve cardiac function and reduce the rate of MACE,but did not have adverseinfluence with the function of liver and kidney，rhabdomyolysis et al.