ABSTRACT
<p><b>Background</b>High platelet reactivity (HPR) during clopidogrel treatment predicts postpercutaneous coronary intervention (PCI) ischemic events strongly and independently. Tongxinluo capsules (TCs) are a traditional Chinese medicine formulation used as antiplatelet treatment. However, its efficacy against HPR is not known. The aim of the present study was to evaluate the effects of TCs in acute coronary syndrome (ACS) patients with HPR.</p><p><b>Methods</b>This multicenter, randomized, double-blind, placebo-controlled study prospectively analyzed 136 ACS patients with HPR who underwent PCI. The patients were enrolled from November 2013 to May 2014 and randomized to receive placebo or TCs in addition to standard dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. The primary end points were the prevalence of HPR at 30 days and the mean change in P2Yreaction units (PRUs) between baseline and 30 days. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups.</p><p><b>Results</b>Both groups had a significantly reduced prevalence of HPR at 30 days versus baseline, but the TC group, compared with the placebo group, had greater reduction (15.8% vs. 24.8%, P = 0.013), especially among patients with one cytochrome P450 2C19 loss of function (LOF) allele (χ= 2.931, P = 0.047). The TC group also had a lower prevalence of HPR (33.3% vs. 54.2%, t = 5.284, P = 0.022) and superior performance in light transmittance aggregometry and higher levels of high-sensitivity C-reactive protein (hsCRP), but the composite prevalence of ischemic events did not differ significantly (χ= 1.587, P = 0.208).</p><p><b>Conclusions</b>In addition to standard DAPT with aspirin and clopidogrel, TCs further reduce PRU and hsCRP levels, especially in patients carrying only one LOF allele. The data suggest that TCs could be used in combination therapy for ACS patients with HPR undergoing PCI.</p>
ABSTRACT
Objective To explore the safety and efficacy of rosuvastatin on development of contrast-induced acute kidney injury (CIAKI) due to application of diuretic furosemide after coronary or peripheral vascular intervention during perioperative period in patients with diabetes mellitus (DM) associated with mild-moderate renal insufficiency (MMRI). Methods From Dec. 2008 to Oct. 2011, 2998 patients from 53 centers in China were enrolled in a TRACK-D project. Of them 650 patients with type 2 DM and concomitant MMRI, who received furosemide, were divided into rosuvastatin group (n=321) and control group (n=329), and all underwent coronary/peripheral arterial diagnostic angiography or left heart ventricular angiography. Patients in rosuvastatin group were treated by percutaneous intervention with rosuvastatin 10mg/d every evening for five days (two days before and three days after operation), while those in control group did not receive any statins before operation and within 72 hours after operation. Serum creatinine (Scr) was measured 48 hours before and 48 and 72 hours after exposure to contrast medium, and the incidence of CIAKI was simultaneously observed. Clinical follow-up of cardiovascular events was done at the 30th day after treatment, including heart function aggravation, all-cause mortality, renal dysfunction-induced dialysis and hemofiltration, etc. Results Baseline data were similar between the two groups. Patients randomized to the rosuvastatin group had a significantly lower incidence of CIAKI compared with controls (5.0% vs 9.7%, P=0.024). Clinical follow-up done at the 30th day after treatment indicated that there was no statistical difference in incidence of dialysis, hemofiltration and all-cause mortality between rosuvastatin group and control group. Conclusions Rosuvastatin may significantly reduce the risk of CIAKI in patients with DM associated with MMRI and receive the furosemide during the perioperative period.