关键词: 心肌梗死, 急性ST段抬高型心肌梗死, 阿托伐他汀, 预后

Abstract: Objective　To evaluate the effect of high-dose atorvastatin on the short-term prognosis of patients with acute ST-segment elevation myocardial infarction （STEMI） treated by emergency percutaneous coronary intervention （PCI）.Methods　We enrolled 158 cases of acute STEMI from Department of Cardiovascular，the Second Affiliated Hospital of Soochow University from June 2011 to June 2014.We divided the patients into intensive treatment group（receiving treatment with atorvastatin calcium 80 mg daily before PCI but changed to atorvastatin calcium 40 mg daily after PCI，n=79） and standard treatment group（receiving treatment with atorvastatin calcium 20 mg daily before and after PCI，n=79） based on the random number generated by SPSS 17.0.We collected their baseline characteristics，results of arteriography，data about treatment，adverse major adverse cardiovascular events （MACE） within 30 days after PCI，and the event associated with poor prognosis.Results　After PCI，compared with the standard treatment group，intensive treatment group demonstrated less proportion of patients with TIMI 0-2 flow and cardiac function KillipⅢ-Ⅳ grade（P<0.05）.Moreover，within 30 days after PCI，the intensive treatment group showed much lower incidence of MACE〔1.3%（1/79） vs.11.4%（9/79）〕（χ2=6.832，P=0.009），as well as higher event-free survival rate identified by Kaplan-Meier survival analysis（χ2=6.860，P=0.009）.Multiple Cox regression analysis found that，post-procedural TIMI 0-2 flow 〔HR=5.382，95%CI（1.042，27.789），P=0.044〕 and use of bare metal stents 〔HR=9.829，95%CI（1.917，50.386），P=0.006〕 increased the risk of having MACE while intensive treatment with atorvastatin calcium decreased the risk of having MACE 〔HR=0.106，95%CI（0.011，0.993），P=0.049〕.Two groups had no severe liver and kidney failure，myopathy，new-onset diabetes，or contrast-induced nephropathy.Conclusion　For acute STEMI patients with emergency PCI，intensive treatment with atorvastatin calcium during the perioperative period and early post-procedural period can significantly improve the short-term prognosis by enhancing the level of myocardial perfusion immediately after PCI and reducing the incidence of MACE.