[Dr.Vad]

Уважаемые коллеги,

Попалась на глаза недавняя статья от польских коллег (тезисы ниже): впечатляет, что такое несложное лечение улучшает отдаленные результаты в разы. Результат отсутствия рандомизации, плацебы и тп?

Kardiol Pol. 2006 Dec;64(12):1357-1362.
Effects of high-dose statin administered prior to coronary angioplasty on the incidence of cardiac events in patients with acute coronary syndrome.
Chyrchel M, и соавт.

Introduction: Statins given after acute coronary syndrome without ST elevation (NSTE-ACS) reduce the incidence of major adverse cardiac events (MACE) in long-term follow-up. Aim: To evaluate the effects of high-dose statin administered in patients with NSTE ACS and increased CRP level prior to percutaneous coronary intervention (PCI) on the incidence of MACE in long-term follow-up. Methods: The study involved 140 consecutive patients with NSTE ACS and increased CRP level at baseline. Patients from group A (n=54) did not receive statin before PCI, whereas subjects in group B (n=86) were given 80 mg of atorvastatin. Patients in both groups received typical cardiological therapy including aspirin, thienopyridine and low molecular weight heparin. After PCI all patients received 40 mg of atorvastatin. Incidence of MACE (death, myocardial infarction (MI), re-PCI) during long-term followup was evaluated in both groups. Results: Study groups did not differ with respect to demographic parameters and rate of ischaemic heart disease risk factors. Also, no differences occurred regarding CRP level (group A vs. B: hsCRP 10.8+/-1.8 mg/l vs. 8.2+/-2.8 mg/l; p=NS) and TIMI Risk Score (group A vs. B: 4.3+/-0.71 vs. 4.37+/-0.79; p=NS). During long-term follow-up the incidence of MI (9.25% vs. 1.2%, p=0.03), composite endpoint: death + MI (14.8% vs. 2.32%, p=0.013) and death + MI + re PCI (25.9% vs. 8.1%, p=0.006) was significantly higher in group A than group B. Conclusions: Administration of high-dose statin in NSTE ACS patients before PCI was associated with significant reduction of MACE in long-term follow-up.

Конечно, есть наблюдения (ниже), что наличие в анамнезе приема статинов перед кардиохирургическими вмешательствами ассоциируется с улучшенным прогнозом, но вот что бы так, разок назначил загрузочную дозу аторвастатина 80 перед операцией (прямо как клопидогреля 300-600) и все ОК?

Clark LL, и соавт.
Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study.
J Thorac Cardiovasc Surg. 2006 Mar;131(3):679-85.

Pascual DA, и соавт.
Preoperative statin therapy and troponin T predict early complications of coronary artery surgery.
Ann Thorac Surg. 2006 Jan;81(1):78-83