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Journal of ZheJiang University(Medical Science)  2016, Vol. 45 Issue (5): 530-535    DOI: 10.3785/j.issn.1008-9292.2016.09.12
Atorvastatin improves reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by decreasing serum uric acid level
YAN Ling, YE Lu, WANG Kun, ZHOU Jie, ZHU Chunjia
Department of Cardiology, Tongling People's Hospital of Anhui Province, Tongling 244000, China
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Objective: To investigate the effect of atorvastatin on reflow in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and its relation to serum uric acid levels. Methods: One hundred and fourteen STEMI patients undergoing primary PCI were enrolled and randomly divided into two groups:55 cases received oral atorvastatin 20 mg before PCI (routine dose group) and 59 cases received oral atorvastatin 80 mg before PCI (high dose group). According to the initial serum uric acid level, patients in two groups were further divided into normal uric acid subgroup and hyperuricemia subgroup. The changes of uric acid level and coronary artery blood flow after PCI were observed. Correlations between the decrease of uric acid, the dose of atorvastatin and the blood flow of coronary artery after PCI were analyzed. Results: Serum uric acid levels were decreased after treatment in both groups (all P<0.05), and patients with hyperuricemia showed more significant decrease in serum uric acid level (P<0.05). Compared with the routine dose group, serum uric acid level in patients with hyperuricemia decreased more significantly in the high dose group (P<0.05), but no significant difference was observed between patients with normal serum uric acid levels in two groups (P>0.05). Among 114 patients, there were 19 cases without reflow after PCI (16.7%). In the routine dose group, there were 12 patients without reflow, in which 3 had normal uric acid and 9 had high uric acid levels (P<0.01). In the high dose group, there were 7 patients without reflow, in which 2 had normal uric acid and 5 had high uric acid (P<0.05). Logistic regression analysis showed that hyperuricemia was one of independent risk factors for no-reflow after PCI (OR=1.01, 95% CI:1.01-1.11, P<0.01). The incidence of no-flow after PCI in the routine dose group was 21.8% (12/55), and that in the high dose group was 11.9% (7/59) (P<0.01). Conclusion: High dose atorvastatin can decrease serum uric acid levels and improve reflow after PCI in patients with STEMI.

Key wordsHyperuricemia/drug therapy      Myocardial infarction/therapy      Angioplasty, transluminal, percutaneous coronary/methods      Heptanoic acids/therapeutic use      Pyrroles/therapeutic use      No-reflow phenomenon     
Received: 08 January 2016      Published: 25 September 2016
CLC:  R542.22  
Cite this article:

YAN Ling, YE Lu, WANG Kun, ZHOU Jie, ZHU Chunjia. Atorvastatin improves reflow after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by decreasing serum uric acid level. Journal of ZheJiang University(Medical Science), 2016, 45(5): 530-535.

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目的:观察不同剂量阿托伐他汀治疗前后急性ST段抬高型心肌梗死(STEMI)患者血清尿酸水平的变化及其与经皮冠状动脉介入(PCI)治疗后无复流的关系。方法:连续选择安徽省铜陵市人民医院2013年6月至2015年12月入院的114例STEMI患者。所有患者在发病后12 h内行PCI治疗。按照PCI治疗前口服阿托伐他汀剂量的不同,将患者随机分为常规剂量组(55例,阿托伐他汀20 mg)和大剂量组(59例,阿托伐他汀80 mg);然后根据患者初始血清尿酸水平将两组各分为正常尿酸组及高尿酸血症组。观察用药前后两组尿酸水平、PCI治疗后冠状动脉血流的变化。分析尿酸下降幅度、阿托伐他汀剂量与PCI治疗后冠状动脉血流之间的相关性。结果:用药后,常规剂量组和大剂量组患者的尿酸水平均显著下降(均P<0.05),且高尿酸血症患者比正常尿酸患者血清尿酸下降幅度更大(均P<0.05)。与常规剂量组比较,大剂量组高尿酸血症患者的尿酸下降幅度更大(P<0.05);但两组中正常尿酸患者的尿酸下降幅度比较差异无统计学意义(P<0.05)。两组共发生无复流19例,发生率为16.7%。其中,常规剂量组发生无复流12例,正常尿酸者3例,高尿酸血症者9例,两者差异有统计学意义(P<0.01);大剂量组发生无复流7例,正常尿酸者2例,高尿酸血症者5例,两者差异也有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高尿酸血症等因素是直接PCI治疗后无复流现象的独立危险因素(OR=1.01,95%可信区间:1.01~1.11,P<0.01)。阿托伐他汀常规剂量组无复流的发生率为21.8%(12/55),大剂量组为11.9%(7/59),差异有统计学意义(P<0.01)。结论:大剂量阿托伐他汀可能通过降低血尿酸水平改善直接PCI治疗后无复流,通过大剂量阿托伐他汀干预有望改善STEMI患者直接PCI治疗冠状动脉无复流。

关键词: 高尿酸血症/药物疗法,  心肌梗死/治疗,  血管成形术,  经腔,  经皮冠状动脉/方法,  庚酸类/治疗应用,  吡咯类/治疗应用,  无复流现象 
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