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目的研究择期经皮冠状动脉介入术(percutaneous coronary intervention,PCI)前常规剂量他汀治疗对围手术期心肌损伤的影响。方法回顾性分析2006年8月至2010年12月于我院心血管内科住院行择期PCI的冠心病患者共293例,根据术前服用他汀与否分为他汀治疗组和非他汀治疗组。于PCI术后20～24小时采集血标本,检测血浆肌钙蛋白I(cTnI)、肌红蛋白(MYO)水平,作为评估围手术期心肌损伤的指标,并观察住院期间主要不良心血管事件。结果两组患者基线资料基本均衡。他汀治疗组与非他汀治疗组患者PCI术后cTnI升高的发生率分别为22.0%(37/168)与15.2%(19/125),两组患者间差异无统计学意义(P>0.05);两组患者PCI术后cTnI升高3倍以上的发生率分别为3.6%(6/168)与4.8%(6/125),组间差异无统计学意义(P>0.05);PCI术后MYO升高的发生率分别为0.6%(1/168)与2.4%(3/125),两组患者间差异亦无统计学意义(P>0.05)。Logistic回归分析显示,每例患者植入支架数是围手术期心肌梗死唯一的独立预测因子。两组患者住院期间无死亡、心肌梗死、心绞痛复发、紧急血运重建等事件发生。结论择期PCI前常规剂量他汀治疗并不足以降低围手术期心肌损伤的发生率。需要大规模随机对照研究进一步研究、证实。
Objective To study the effect of routine dose of statin before percutaneous coronary intervention (PCI) on perioperative myocardial injury. Methods A retrospective analysis of 293 patients with coronary artery disease who underwent elective PCI in our hospital from August 2006 to December 2010 was divided into statin group and non-statin group according to preoperative statin therapy. Blood samples were taken from 20 to 24 hours after PCI, and the levels of plasma cTnI and myoglobin (MYO) were measured as indicators of perioperative myocardial damage. The main adverse cardiovascular events during hospitalization were observed. Results The baseline data of the two groups were basically balanced. The incidences of elevated cTnI after PCI in statin-treated and non-statin-treated patients were 22.0% (37/168) and 15.2% (19/125) respectively, with no significant difference between the two groups (P> 0.05) . The incidence of cTnI more than 3 times after PCI in both groups was 3.6% (6/168) vs 4.8% (6/125) respectively. There was no significant difference between the two groups (P> 0.05). After PCI The prevalence of MYO was 0.6% (1/168) and 2.4% (3/125) respectively, with no significant difference between the two groups (P> 0.05). Logistic regression analysis showed that the number of stents implanted in each patient was the only independent predictor of perioperative myocardial infarction. There was no death, myocardial infarction, recurrence of angina pectoris and emergency revascularization in the two groups during hospitalization. Conclusions Elective conventional PCI before elective PCI is not sufficient to reduce the incidence of perioperative myocardial damage. Need for large-scale randomized controlled studies to further study, confirmed.