The Effects of Starting Statin Therapy Prior to Percutaneous Coronary Intervention with Drug-Eluting Stent on Postprocedural Myonecrosis and Clinical Outcome

在裝置塗藥支架之介入治療術前即開始使用Statin類藥物對術後心肌受損及預後之影響

任勗龍(Hsu-Lung Jen) ； 殷偉賢(Wei-Hsian Yin) ； 江孟橙(Meng-Cheng Chiang) ； 王鑑忠(Jiann-Jong Wang) ； 黃文彬(Wen-Pin Huang) ； 馮安寧(An-Ning Feng) ； 楊永年(Yung-Nien Yang) ； 林昌琦(Chang-Chyi Lin) ； 董道興(Tao-Hsin Tung) ； 楊茂勳(Mason Shing Young)

《Acta Cardiologica Sinica》 23卷2期 (2007/06) Pp. 71-78

摘要

Background: Statin therapy prior to or soon after percutaneous coronary intervention (PCI) is associated with improved clinical outcome in those patients. Recent trials have demonstrated that drug-eluting stent (DES) can reduce stent failure due to restenosis. The objective of this study was to determine whether starting statin treatment prior to PCI with DES reduced periprocedural myonecrosis and improved clinical outcome.
Methods: A total of 161 patients (aged 66.2±10.6 years, M/F=116/45) with stable or unstable angina pectoris who underwent PCI with DES were enrolled. Statin therapy was administered at the discretion of the attending physician. We compared the pen-procedural serum levels of creatine phosphokinase (CPK) and MB-fraction of creatine phosphokinase (CK-MB), the incidence of myonecrosis, defined as elevation of peak CK-MB above upper limit of normal within 24 hours after the index procedure, and the major adverse cardiovascular event (MACE) rates up to 9 months between the statin-treated (statin group; n=63) and non-statin-treated (non-statin group; n=98) patients. Major adverse cardiovascular events were defined as cardiac death, nonfatal myocardial infarction or stroke, or re-intervention procedure.
Results: The baseline and procedural data were similar in both groups. However, statin-treated patients were more likely to have hyperlipidemia (81.0% vs. 62.2%; P=0.01), younger age (61.9 years vs. 69.0 years; P＜0.0001), and longer lesion length (22.07mm vs. 17.30mm; P=0.05) than non-statin-treated patients. Postprocedural peak levels of CK-MB (10.32IU/L vs. 17.05IU/L; P=0.04) and the incidence of myonecrosis (24% vs. 46%; P=0.05) were significant lower in the statin group than those in the non-statin group. Within a 9-month period, receiving statin therapy was not associated with a significant reduction of MACE (log rank test, P=0.44).
Conclusion: Our data demonstrate that starting statin therapy before PCI with DES can reduce periprocedural myonecrosis. Whether statin therapy can improve long-term clinical outcome in those patients needs to be confirmed in larger prospective randomized trials.

關鍵字

Statin類降血脂藥物 ； 塗藥支架 ； 介入治療術 ； 心肌受損 ； 臨床預後

並列摘要

Background: Statin therapy prior to or soon after percutaneous coronary intervention (PCI) is associated with improved clinical outcome in those patients. Recent trials have demonstrated that drug-eluting stent (DES) can reduce stent failure due to restenosis. The objective of this study was to determine whether starting statin treatment prior to PCI with DES reduced periprocedural myonecrosis and improved clinical outcome.
Methods: A total of 161 patients (aged 66.2±10.6 years, M/F=116/45) with stable or unstable angina pectoris who underwent PCI with DES were enrolled. Statin therapy was administered at the discretion of the attending physician. We compared the pen-procedural serum levels of creatine phosphokinase (CPK) and MB-fraction of creatine phosphokinase (CK-MB), the incidence of myonecrosis, defined as elevation of peak CK-MB above upper limit of normal within 24 hours after the index procedure, and the major adverse cardiovascular event (MACE) rates up to 9 months between the statin-treated (statin group; n=63) and non-statin-treated (non-statin group; n=98) patients. Major adverse cardiovascular events were defined as cardiac death, nonfatal myocardial infarction or stroke, or re-intervention procedure.
Results: The baseline and procedural data were similar in both groups. However, statin-treated patients were more likely to have hyperlipidemia (81.0% vs. 62.2%; P=0.01), younger age (61.9 years vs. 69.0 years; P＜0.0001), and longer lesion length (22.07mm vs. 17.30mm; P=0.05) than non-statin-treated patients. Postprocedural peak levels of CK-MB (10.32IU/L vs. 17.05IU/L; P=0.04) and the incidence of myonecrosis (24% vs. 46%; P=0.05) were significant lower in the statin group than those in the non-statin group. Within a 9-month period, receiving statin therapy was not associated with a significant reduction of MACE (log rank test, P=0.44).
Conclusion: Our data demonstrate that starting statin therapy before PCI with DES can reduce periprocedural myonecrosis. Whether statin therapy can improve long-term clinical outcome in those patients needs to be confirmed in larger prospective randomized trials.

並列關鍵字

Statins ； Drug-eluting stent ； Percutaneous coronary intervention ； Myonecrosis ； Clinical outcome