| Objective This study is designed to investigate the myocardial protective effects and safety of atrovastatin of different loading dose in patients with acute coronary syndromes(ACS) undergoing selective percutaneous coronary intervention(s PCI),and to evaluate its effects on the prognosis of these patients.Methods Totally, two hundreds and forty four patients with acute coronary syndrome(ACS) who were prepared for percutaneous coronary intervention(PCI) in our hospital,were randomly divided into three groups: 20 mg atrovastatin group(group A,84cases), 40 mg atorvastatin group(group B,76cases) and 80 mg atorvastatin group(group C,84cases). At 12 hours before PCI,one time intake of oral atorvastatin was administered for patients in each group(20mg, 40 mg and 80 mg for group A, B and C, respectively) and then 20mg/day for the following days. During PCI, the TIMI flow was observed, the level of cardiac troponin(c Tn I), creatine kinase isoenzyme-MB(CK-MB), homocysteine(HCY), high sensitive C reactive protein(hs-CRP) were recorded. All patients were followed up for 30 days, the major adverse cardiac events(MACEs) during hospital stay and the 30 days follow up were recorded. The hepatic enzyme(ALT) and musles enzyme(CK) were measured 1 month and 3 month post PCI, and, that over 3 times elevation of ALT was diagnosised as drug induced hepatic injury, myalgia or over 10 times elevation of CK was diagnosised as myopathy. Ultracardigraphy was performed before PCI and 3 months post PCI. The end diastolic diameter(EDD), end systolic diameter(ESD), ejection fraction(EF) and wall motion score index(WMSI) were measured.Results After PCI, the TIMI flow grade 3 was found in 70 patients in group A, 67 patients in group B and 81 patients in group C. TIMI flow grade is obviously the best in group C among the three groups(group A: 83.3% vs group B 88.2% vs group C 96.4%,P=0.021).There weren’t significant differences for CK-MB level among the three groups. The level of CK-MB in group A and B post PCI increased significantly(A:15.85±5.31 vs 19.77±10.43U/L P<0.01;B:14.56±3.41 vs 18.42±3.42U/L P<0.01), while the level of CK-MB in group C not changed(15.88±5.26 vs 14.47±4.20 P).For the levels of CK-MB post PCI, there was not significant difference between A and B, but level of group C was significantly decreased(A:19.77±10.43U/L vs B:18.42±3.42U/L vs C:14.47±4.20,P<0.01).There weren’t significant differences for c Tn I level among the three groups. The level of c Tn I in group A, B and C post PCI increased significantly(A:0.21±0.14 vs 0.90±0.70ng/ml;B:0.24±0.11 vs 0.88±0.54 ng/ml;C:0.23±0.10 vs 0.61±0.48ng/ml P<0.05).For the levels of c Tn I post PCI, group C was significantly decreased(A:0.90±0.70ng/ml vs B:0.88±0.54 ng/ml vs C:0.61±0.48ng/ml P=0.002).The level of hs-CRP and HCY before PCI were not different among the three groups, but all have a trend of increase(no significance). If the extent of increase of hs-CRP and HCY before and after PCI were compared, the lowerest value was found in group C(P<0.01), while there was no difference between group A and B(hs-CRP: A 1.08±0.92mg/l vs B:1.05±0.84 mg/l vs C:0.63±0.35 mg/l; HCY: A: 1.12±0.93umol/l vs B: 1.00±0.99 umol/l vs C: 0.58±0.92 umol/l).After 30 days of follow up, no sudden cardiac death, acute myocardial infarction and acute revascularization were recorded. For the recurrence of angina pectoris within the follow-up days, there wasn’t difference between group A and B, while group C was the lowerest(A: 15.5% vs B: 13.2% vs C: 3.6% P=0.033).No side effect of the drugs was reported, except one case of acute hepatic injury in group A(no significance).For the echocardiography, the ejection fraction increased, while EDD decreased, for all groups at 3 months post PCI(EF: A:61±6.6 vs 64±6.8;B:62±8.5 vs 65±8.4; C:61±5.9 vs 64±6.1.EDD:A:5.11±0.58 cm vs4.81±0.64cm;B:5.01±0.43 cm vs 4.66±0.55cm;C:5.03±0.59 cm vs 4.76±0.68cm).The WMSI in group C was the lowerest among the three groups(A: 1.03±0.09 vs B: 1.04±0.09 vs C: 1.00±0.07,P=0.026).Conclusions For ACS patients undergoing selective PCI therapy, when atorvastatin preconditioning 12 hours before PCI was given, compared with the loading does of 20mg:1. 80 mg atorvastatin has significant anti-inflammatory and endothelium protect effects, while these effects were not found in 40 mg atorvastatin group.2. 80 mg atorvastatin effectively improves myocardial blood perfusion and reduce myocardial injury during PCI, while these effects were not found in 40 mg atorvastatin group.3. 80 mg atorvastatin reduces the ocurrence of MACEs within the 30 following days, while this was not found in 40 mg atorvastatin group..4. 80 mg atorvastatin effectively improves the ventricular wall motion. |
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