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Objective To evaluate the preventive effect of a high loading dose of Rosuvastatin on contrast-induced nephropathy (CIN )after PCI in high-risk patients. Methods A total of 199 patients with diabetes mellitus and chronic kidney disease (CKD)(45< GFR<90 ml · min-1 · 1.73 m -2 )scheduled for PCI were included and randomized into two groups ,one group receiving a high loading dose of rosuvastatin(20 mg Rosuvastatin in 3 days before and after PCI ,Rosuvastatin Group-RG)and the other one (Control-Group-CG)receiving 10 mg/d Rosuvastatin.Serum samples were collected at baseline ,48 and 72 hours after PCI for testing of creatinine ,C-reactive protein (CRP ) , interleukin-6(IL-6) ,and malondialdehyde(MDA). Results Post-PCI levels of CRP ,IL-6 ,and MDA in the RG were significantly lower than in the CG [(10.44 ± 3.82 )mg/L vs. (12.62 ± 3.68) mg/L , (14.66 ± 3.61 )ng/L vs. (16.41 ± 4.73 )ng/L ,(7.2 ± 2.2) mmol/L vs. (8.6 ± 1.5) mmol/L ,P=0.000 ,0.004 ,and 0.000 ,respectively].The levels of creatinine after PCI in both groups were found to be higher than baseline levels ,while the increase in the RG was smaller than in the CG [(10 ± 10)μmol/L vs. (15 ± 15)μmol/L ,P=0.007]. The incidence of CIN in the RG was lower than in the CG (8.2％ vs.19.8％ ,χ2 = 5.573 ,P= 0.018). Conclusions High-dose Rosuvastatin treatment can reduce the incidence of CIN in high-risk patients undergoing PCI.
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Objective To investigate the effect of time from myocardial infarction (MI) onset to percutaneous coronary intervention (PCI) on plasma matrix metalloproteinases (MMPs) level and left ventricle (LV) remodeling in patients with acute ST-segment elevation myocardial infarction of anterior wall,and the relationship between MMPs and left ventricular remodeling.Methods All patients with anterior wall STEMI undergoing PCI were divided into early PCI group (PCI within 18 h after MI onset) and delayed PCI group (PCI between 2 and 3 weeks after MI onset).Plasma MMP-2 and MMP-9 activities were assayed on admission,and at 2 days,1 week after admission.One-year follow-up was finished after PCI.Left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV) and left ventricle ejection fraction (LVEF) were measured by echocardiography at baseline and one year later to elucidate the effects of time from onset to PCI on LV remodeling and the relationship between MMP-2,-9 levels and LV remodeling.Results The MMP -9 activity at 2 days after myocardial infarction was lower in early PCI group than in delayed PCI group [(46±26)μg/L vs.(66±40) μg/L,P=0.000].The changes in LVEDV and LVESV (△LVEDV and △LVESV) were lower and the change in LVEF (△LVEF) was higher in early PCI group than in delayed PCI group [(10.9±6.2) ml vs.(15.0±6.0)ml,(-1.1±5.7) ml vs.(2.9±4.6) ml,(5.5 ±4.0) ％ vs.(3.8±3.4) ％,P=0.000,0.000 and 0.015].MMP-9 had positive correlations with △LVEDV and △LVESV,and a negative correlation with △LVEF at admission and after 1-year follow-up (r=0.32,0.36 and-0.29,respectively,P=0.000,0.000 and 0.001).Conclusions MMP-9 activity at admission is correlated with LV remodeling and LV function.Early PCI can reduce MMP-9 activity and improve LV remodeling after myocardial infarction.
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Objective This study was conducted to investigate the clinical outcomes and safety of percutaneous coronary intervention (PCI) to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction. Methods Twenty-seven patients with severe left ventricular systolic dysfunction (ejection fraction≤35%) undergoing PCI were included. All the patients received PCI only to the single-opened vessel lesion under the conditions of: (1) There were limitations to open chronic total occlusion (CTO);(2) Single-opened vessel lesion was not calcified and tortuous. Clinical outcomes, including success rate of PCI, changes of symptoms in-hospital, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) pre-and one week post-PCI, the major adverse cardiac events (MACE, including death, myocardial infarction and target vessel revascularization) at 30-days after discharged were observed. Results The success rate of PCI was obtained in all 27 patients(100%), and all the patients received drug eluting stent implantation. The symptoms improvement occurred in all patients and the NYHA class improved from grade Ⅳto grade Ⅲin 22 patients(81.5%) in-hospital. Significant differences were noted in the mean BNP and LVEF between pre-PCI and one week post-PCI, BNP[(2699.6±1104.7) pg/ml vs. (737.0 ± 261.7) pg/ml, P<0.05],LVEF[(26.9±5.7)%vs. (36.0±3.41)%, P<0.05)]. No MACE happened in-hospital and at 30-days follow up. Conclusions PCI only to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction under the condition of limitations to open CTO is safe and can significantly improve clinical outcomes in-hospital and at 30-days follow up, but it must be emphasized that single-opened vessel lesion not with obvious calcification and tortuosity.