阿托伐他汀在ACS方面的作用.ppt

高筑门诊他汀防线 遏制冠心病向ACS转化——再谈慢性稳定型冠心病患者他汀管理策略 Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention Results From the ARMYDA-1 (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) Study Vincenzo Pasceri, MD, PhD; Giuseppe Patti, MD; Annunziata Nusca, MD; Christian Pristipino, MD;Giuseppe Richichi, MD; Germano Di Sciascio, MD; on behalf of the ARMYDA Investigators Background—Small myocardial infarctions after percutaneous coronary intervention have been associated with higher risk of cardiac events during follow-up. Observational studies have suggested that statins may lower the risk of procedural myocardial injury. The aim of our study was to confirm this hypothesis in a randomized study. Methods and Results—One hundred fifty-three patients with chronic stable angina without previous statin treatment were enrolled in the study. Patients scheduled for elective coronary intervention were randomized to atorvastatin (40 mg/d, n76) or placebo (n77) 7 days before the procedure. Creatine kinase-MB, troponin I, and myoglobin levels were measured at baseline and at 8 and 24 hours after the procedure. Detection of markers of myocardial injury above the upper normal limit was significantly lower in the statin group versus the placebo group: 12% versus 35% for creatine kinase-MB (P0.001), 20% versus 48% for troponin I (P0.0004), and 22% versus 51% for myoglobin (P0.0005). Myocardial infarction by creatine kinase-MB determination was detected after coronary intervention in 5% of patients in the statin group and in 18% of those in the placebo group (P0.025). Postprocedural peak levels of creatine kinase-MB (2.93 versus 7.518 ng/mL, P0.007), troponin I (0.090.2 versus 0.471.3 ng/mL, P0.0008), and myoglobin (5836 versus 8149 ng/mL, P0.0002) were also significantly lower in the statin than in the placebo group. Conclusions—Pretreatment with atorvastatin 40 mg/d for 7 days significantly reduces procedural myocardial injur