초록접수 현황
| 14F-142 | 구연 발표 |
Impact of High-dose Pretreatment of Rosuvastatin in Patients with Acute Coronary Syndrome Following Off-pump Coronary Artery Bypass: Results from the Prospective Randomized HIROP-ACS Study
윤영남 1, 이승현 1, 김중선 2, 조인정 2, 곽영란 3, 최동훈 2, 유경종 1
1 Division of Cardiovascular Surgery, 2 Division of Cardiology, 3 Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System
Background : Periprocedural treatment with high-dose statins is known to have cardioprotective and pleiotropic effects, such as anti-thrombotic and anti-inflammatory actions. We aimed to assess the efficacy of high-dose rosuvastatin pre-treatment in patients with acute coronary syndrome (ACS) undergoing off-pump coronary artery bypass grafting (OPCAB).
Methods : A total of 234 patients with ACS scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60 mg rosuvastatin (n=117) or placebo (n =117) before OPCAB. Transthoracic echocardiography and biomarkers were measured at the time of randomization and at designated intervals after surgery. The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACEs) defined as all-cause death, non-fatal myocardial infarction, and target vessel revascularization. The secondary endpoints were changes in echocardiographic parameters including wall motion score index (WMSI), ventricular dimensions and ejection fraction, the levels of biological markers, atrial arrhythmia, and acute kidney injury during hospital stay.
Results : There was no difference in pre-, and intra-opeartive characteristics between two arms. The primary endpoint occurred in 3 patients (2.6%) of the rosuvastatin arm and 6 patients (5.1%) of the placebo arm, respectively (p=0.49). However, the postoperative WMSI was significantly decreased in the rosuvastatin arm (1.35 vs. 1.50, p=0.04) and the peak levels of creatine kinase-MB, troponin T (TnT), high-sensitivity C-reactive protein (hs-CRP), CRP and erythrocyte sedimentation rate (ESR) at postoperative period was significantly lower in the rosuvastatin arm. Moreover, the postoperative elevation of cardiac biomarkers (10 times above upper limit of normal) was significantly higher in the placebo arm (CK-MB, 0.9% vs. 6.8%, p=0.04; TnT, 5.1% vs. 12.8%, p=0.04). Rosuvastatin loading was not associated with the postoperative occurrence of atrial arrhythmia (17.1% vs. 23.9%, p=0.20) or acute kidney injury (30.8% vs. 31.0%, p=1.00).
Conclusion : Our findings suggest that high-dose rosuvastatin loading before OPCAB in patients with ACS was associated with the protection of myocardial ischemia.
Methods : A total of 234 patients with ACS scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60 mg rosuvastatin (n=117) or placebo (n =117) before OPCAB. Transthoracic echocardiography and biomarkers were measured at the time of randomization and at designated intervals after surgery. The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACEs) defined as all-cause death, non-fatal myocardial infarction, and target vessel revascularization. The secondary endpoints were changes in echocardiographic parameters including wall motion score index (WMSI), ventricular dimensions and ejection fraction, the levels of biological markers, atrial arrhythmia, and acute kidney injury during hospital stay.
Results : There was no difference in pre-, and intra-opeartive characteristics between two arms. The primary endpoint occurred in 3 patients (2.6%) of the rosuvastatin arm and 6 patients (5.1%) of the placebo arm, respectively (p=0.49). However, the postoperative WMSI was significantly decreased in the rosuvastatin arm (1.35 vs. 1.50, p=0.04) and the peak levels of creatine kinase-MB, troponin T (TnT), high-sensitivity C-reactive protein (hs-CRP), CRP and erythrocyte sedimentation rate (ESR) at postoperative period was significantly lower in the rosuvastatin arm. Moreover, the postoperative elevation of cardiac biomarkers (10 times above upper limit of normal) was significantly higher in the placebo arm (CK-MB, 0.9% vs. 6.8%, p=0.04; TnT, 5.1% vs. 12.8%, p=0.04). Rosuvastatin loading was not associated with the postoperative occurrence of atrial arrhythmia (17.1% vs. 23.9%, p=0.20) or acute kidney injury (30.8% vs. 31.0%, p=1.00).
Conclusion : Our findings suggest that high-dose rosuvastatin loading before OPCAB in patients with ACS was associated with the protection of myocardial ischemia.
책임저자: 유경종
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
연락처 : 유경종, Tel: 02-2228-8480 , E-mail : kjy@yuhs.ac
