OBJECTIVE:It has earlier been suggested that postoperative thrombocytosis frequently occur after coronary artery bypass grafting (CABG) and may be linked to lipid disturbances. A prospective randomized study was undertaken to evaluate if preoperative lipid-control, using HMG-CoA-reductase inhibitor (Zocor), simvastatin, reduces the risk of postoperative thrombocytosis. METHODS:Seventy-seven patients with symptomatic coronary artery disease and hypercholesterolemia (total cholesterol > or =6.2 mmol/l), planned for CABG where randomly assigned to; undergo CABG without preoperation lipid control (group I, n = 37) or undergo simvastatin-treatment (20 mg daily) to control their lipids (4 weeks) prior to CABG (group II, n = 40). RESULTS:Patient characteristics and operation data did not differ between the groups. Serum-cholesterol, cholesterol/HDL-cholesterol, LDL-cholesterol, Apolipoprotein A1 and Plasminogen were all significantly higher in group I patients compared with group II just prior to surgery. Other laboratory parameters did not differ. RESULTS:In group II, total cholesterol and cholesterol/HDL-cholesterol quota were significantly lowered by simvaststin (-2 and -29%, respectively). Postoperative thrombocytosis (platelet counts > or =400000/microl) occurred significantly more frequently in group I 81% (30/37) compared with 3% (1/40) in group II, P<0.0001. Myocardial infarction after the 7th postoperative day was more often diagnosed in group I, 14 vs. 0% in group II. Postoperative transient renal failure occurred also more frequently in group I, 24% compared with 8% in group II. Other postoperative complications and laboratory data did not differ. CONCLUSIONS:This study once again underlines the importance of lipid control using HMG-CoA-reductase inhibitors (e.g. Zocor) in patients with established coronary artery disease. For the first time it is shown that lipid-control with simvastatin prior to CABG reduces the risk of postoperative thrombocytosis, thus lowers the risk for thrombotic complications.

译文

目的:早期曾有人提出冠状动脉搭桥术(CABG)后常发生术后血小板增多症,并可能与脂质紊乱有关。进行了一项前瞻性随机研究,以评估术前使用HMG-CoA-还原酶抑制剂(Zocor)辛伐他汀进行脂质控制是否能降低术后血小板增多症的风险。
方法:77例有症状的冠状动脉疾病和高胆固醇血症(总胆固醇>或= 6.2 mmol / l)的患者计划随机分配至CABG;在未进行术前血脂控制的情况下进行CABG治疗(I组,n = 37)或在进行CABG治疗前(4周)进行辛伐他汀治疗(每天20 mg)以控制血脂(II组,n = 40)。
结果:两组之间的患者特征和手术数据没有差异。 I组患者的血清胆固醇,胆固醇/ HDL胆固醇,LDL胆固醇,载脂蛋白A1和纤溶酶原均显着高于手术前的II组。其他实验室参数没有差异。
结果:在第二组中,辛伐他汀显着降低了总胆固醇和胆固醇/高密度脂蛋白胆固醇(分别为-2%和-29%)。 I组术后血小板增多症(血小板计数>或= 400000 /μl)的发生率明显高于II组3%(1/40)的81%(30/37),P <0.0001。术后第7天心肌梗死在I组中被更频繁地诊断出,14组比II组中的0%更容易被诊断出。 I组术后短暂性肾功能衰竭的发生率也更高,为24%,而II组为8%。其他术后并发症和实验室数据无差异。
结论:这项研究再次强调了使用HMG-CoA-还原酶抑制剂(例如Zocor)控制血脂对已确诊的冠心病患者的重要性。首次显示在CABG之前用辛伐他汀进行脂质控制可降低术后血小板增多症的风险,从而降低血栓并发症的风险。

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