| Objective: To evaluate the safety and efficacy of different doses of rosuvastatin on the basis of routine treatment in patients with acute ST-elevation elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods: Retrospective study: Enrolled STEMI patients who were hospitalized from the Department of cardiac intensive care unit(CCU)at the Second Hospital of Tianjin Medical University from February 2014 to February 2015 that treated with rosuvastatin.According to the follow-up record of 1 month after discharge,a total of115 patients were enrolled in the study.The patients underwent emergency PCI.All patients underwent statin therapy within 24 hours after admission.Patients were divided into low-dose group(n = 44)and middle-dose group(n=71)according to the dose of rosuvastatin therapy that with oral administration of rosuvastatin calcium tablets 5 mg /d were set to low-dose group;oral administration of rosuvastatin calcium tablets 10 mg / d of the patients set as the middle-dose group.Data regarding biochemical parameter such as creatinine(Cr),fibrinogen(Fib),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),and High density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were collected of all patients during hospitalization and one month after discharge.Also,adverse drug reactions and major cardiovascular events(MACE)(malignant arrhythmia,heart failure,recurrent angina,target vessel reperfusion therapy,death)were recorded one month after discharge.Prospective study: Continuous enrolled 113 patients with STEMI who were hospitalized from CCU in our hospital from April 2016 to February 2017 and received rosuvastatin treatment;all patients underwent emergency PCI.All patients underwent statin therapy within 24 hours after admission.Patients were randomly divided into middle-dose group(n = 58)and high-dose group(n = 55),Patients in the middle-dose group were given 10 mg rosuvastatin calcium tablets per day,whilepatients in high-dose group was given 20 mg rosuvastatin calcium tablets per day.The levels of ALT,AST,renal function(Cr),TC,TG,LDL-C,HDL-C,creatine kinase(CK),creatine kinase isoenzyme(CK-MB),Troponin I(cTnI),type B natriuretic peptide(BNP),high sensitivity C-reactive protein(Hs-CRP)and human plasma lipoprotein phospholipase A2(Lp-PLA2)were measured during hospitalization and one month after discharge.,meantime,adverse drug reactions and major cardiovascular events(MACE)were recorded during follow-up.Results: Retrospective study: intra-group comparison: After treatment,the levels of TC,LDL-C,ALT and AST were significantly lower than those before treatment(P<0.05).(2)After treatment,TG and HDL-C levels were significantly lower than those before treatment(P> 0.05).Comparison between groups:(1)There was no significant difference in the levels of TC,TG,HDL-C,LDL-C,ALT and AST between the two groups before and after treatment(P> 0.05).(2)There was no significant difference in LDL-C compliance rate between the two groups after treatment(?2=0.883,P=0.347).(3)There were no serious adverse drug reactions during the follow-up period.(4)The incidence of MACE during the follow-up period was significantly lower in the middle-dose group than in the low-dose group(P <0.05).There was no significant difference between the two groups in the incidence of heart failure and angina(P>0.05).During the follow-up period,there was no target vessel repair and death.Prospective study: intra-group comparison:(1)After treatment,the levels of TC,TGand LDL-C in the two groups were significantly lower than those before treatment(P <0.05),the level of HDL-C in the middle-dose group was not significantly changed before and after treatment(1.07±0.19 vs 1.05±0.29,P>0.05),the level of HDL-C in the high-dose group was significantly higher than that before treatment(1.09±0.19 vs 0.97±0.22,P<0.05).(2)The levels of Lp-PLA2,CRP and BNP in the two groups were significantly lower than those before treatment(P <0.05).(3)The levels of CK,CK,MB,ALT,AST and BUN in the middle-dose group were significantly lower than those before treatment,there was no significant change in the level of Cr(P> 0.05).The levels of CK,CK-MB,Cr and AST in the high-dose group were significantly lower than those before treatment(P <0.05).There was nosignificant change in ALT and BUN(P> 0.05).Comparison between groups:(1)There was no significant difference in the levels of TG(2.63±2.62 vs 2.25±1.55),TC(4.75±1.06 vs 4.76±1.25),LDL-C(2.89±0.70 vs2.88±0.97)and HDL-C(0.97±0.22 vs 1.05±0.29)between the two groups before treatment(P> 0.05);after treatment,the levels of TG(1.45±0.87 vs 1.84±0.96),TC(3.48±0.90 vs 3.88±0.82)and LDL-C(1.77±0.58 vs 2.07±0.71)in the high-dose group were significantly lower than those in the middle-dose group(P <0.05).However,after treatment,there was no significant difference in HDL-C level between the high-dose group and the middle-dose group(1.09±0.19 vs 1.07±0.19,P> 0.05).Regarding the LDL-C compliance rate,there were 24 cases(41.4%)in the dose group and 37cases(67.3%)in the high-dose group,the difference was statistically significant(? 2=7.619,P=0.006).(2)There was no significant difference in Lp-PLA2[124.15(98.18,166.01)vs 124.43(67.07,164.15)]?CRP[6.68(3.04,16.75)vs6.37(2.98,12.37)]and BNP[91.70(61.50,169.00)vs 91.60(58.58,280.70)] between the two groups before treatment(P> 0.05),after treatment,the differences of Lp-PLA2[67.82(59.72,79.68)vs 88.83(67.38,133.52)] ? CRP[0.98(0.68,2.06)vs3.68(2.58,4.74)] and BNP[56.30(38.10,77.30)vs 65.90(56.22,88.55)] were statistically significant(P<0.05).(3)There was no significant difference in CK,CK-MB,ALT,AST,Cr and BUN between the two groups before treatment(P> 0.05),the difference of ALT,AST,Cr between the two groups was statistically significant after treatment(P<0.05).(4)There was no significant difference in serious adverse events such as severe myopathy,rhabdomyolysis,and renal impairment were observed during the follow-up period.(5)In the case of MACE during follow-up,10cases(17.2%)of patients in the middle-dose group developed angina pectoris after infarction,and 2 cases(3.66%)of high-dose group developed angina pectoris after infarction,the difference was statistically significant(P<0.05),there was no significant difference in the incidence of shock,heart failure,recurrent myocardial infarction,malignant arrhythmia,reperfusion therapy and death.There were 22patients(37.9%)with MACE in the middle-dose group and 9 patients(16.4%)with MACE in the high-dose group,the difference was statistically significant(P = 0.01).Coclusions: The use of high-dose rosuvastatin in patients with STEMI can significantly reduce blood lipid levels and significantly increase the compliance rate of LDL-C in patients after 1 month.The use of high-dose rosuvastatin in patients with STEMI can significantly reduce vascular inflammation response to improve vascular endothelial function;patients with STEMI use high-dose rosuvastatin treatment without increasing adverse drug adverse events. |
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