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題 名 | 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 |
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作 者 | 任勗龍; 殷偉賢; 江孟橙; 王鑑忠; 黃文彬; 馮安寧; 楊永年; 林昌琦; 董道興; 楊茂勳; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 23:2 2007.06[民96.06] |
頁 次 | 頁71-78 |
分類號 | 416.262 |
關鍵詞 | Statin類降血脂藥物; 塗藥支架; 介入治療術; 心肌受損; 臨床預後; Statins; Drug-eluting stent; Percutaneous coronary intervention; Myonecrosis; Clinical outcome; |
語 文 | 英文(English) |
中文摘要 | 背景 在冠狀動脈介入治療術前或稍後使用Statin類降血脂藥物可有效改善此類患者之臨床預後。裝置塗藥支架則證實可有效減少介入治療術後血管再狹窄的發生。然而若在置放塗藥支架前即開始使用Statin類藥物是否能減少術後之心肌受損且改善臨床預後則不得而知,也是本研究探討的主題。 方法 本研究收集本院161位因冠心症合併心絞痛而接受例行介入治療並裝置塗藥支架的患者進行分析,病患是否使用Statin類降血脂藥物由其主治醫師自行決定。病患依是否使用Statin類降血脂藥物分為兩組:自術前即開始使用Statin類藥物且術後持續使用者為Statin組 (N=63);自術前至術後第九個月止約未使用該類藥物者為Non-Statin組 (N=98)。我們在術前及術後第6至8,必時及第16至24小時共抽血三次測其血清中CPK及CK-MB的數值,以評估術後心肌受損的程度。所有病患並追蹤至術後第九個月,統計其是否發生死亡、復發心肌梗塞、腦中風及血管再阻塞而需重行介入治療等重大心血管事件之發生率。 結果 Statin組患者與Non-statin組患者相較,其基本臨床及手術資料類似,然而前者之高血脂症發病率較高 (81.0%vs. 62.2%; P=0.01)、年齡較輕(61.9歲vs. 69.0歲;P<0.0001)、且血管病灶較長(22.07mm vs. 17.30mm; P=0.05)。Statin組其代表心肌受損之術後CK-MB最高值明顯低於Non-statin組(10.32IU/L vs. 17.05IU/L; P=0.04);其術後CK-MB超過正常值之心肌受損發生率也明顯少於Non-statin組 (24% vs. 46%; P=0.05)。追蹤至術後第九個月時,Statin組之重大心血管事件之發生率與Non-statin組相近 (log rank test, P=0.44)。 結論 在裝置塗藥支架之介入治療術前即開始使用Statin類藥物可減少術後心肌受損。至於是否能改善長期臨床預後,仍須大型前瞻性隨機研究加以驗證。 |
英文摘要 | 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. |
本系統中英文摘要資訊取自各篇刊載內容。