الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Early PCI is the method of choice for myocardial infarction with ST elevation, and a shorter interval between event and hospital arrival can result in lower mortality rates. Coronary angiography is the most common heart procedure worldwide, and contrast-induced nephropathy (CIN) has shown increased rates in those undergoing this modality. CIN is the increase of more than 25% or more than 0.5 mg/dl (44 μmol/l) of serum creatinine from baseline within 48 − 72 h following intravenous injection of contrast material usually peaking on the third to fifth dayand returning to baseline values within 10–14 days. The overall incidence of CIN in the general population has been estimated to be 1–6%. Furthermore, it may increase the risk of hemodialysis and death. CIN may be secondary to direct tubular toxicity, vasoconstriction, and oxidative stress. Statins may lessen atherosclerosis, inflammation, endothelial dysfunction, and platelet hyperactivity. Good effects of statins such as atorvastatin and rosuvastatin on oxidative stress, nitric oxide synthesis, and endothelial function constitute some of the mechanisms responsible for the reno- protective effects in those with chronic kidney disease. Statins work by competitively blocking the active site of the first and key rate-limiting enzyme in the mevalonate pathway, HMG-CoA reductase, inhibition of this site prevents substrate access, thereby blocking the conversion of HMG-CoA to mevalonic acid. Within the liver, this reduces hepatic cholesterol synthesis, leading to increased production of microsomal HMG-CoA reductase and increased cell surface LDL receptor expression. This facilitates increased clearance of LDL-c from the bloodstream and a subsequent reduction in circulating LDL-c levels by 20% to 55%. • This study was designed to compare the efficacy of loading dose atorvastatin defined as 80 milligrams versus loading dose rosuvastatin defined as 40 milligrams for the prevention of contrast induced nephropathy in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. 150 ST segment elevation myocardial infarction patients were enrolled in the study at the Department of Cardiology, Tanta university hospitals. Patients were divided into 2groups: • group 1: 75 patients with clinical features of ST elevation myocardial infarction received atorvastatin (80 mg) before undergoing the primary PCI • group 2: 75 patients with clinical features of ST elevation myocardial infarction received rosuvastatin (40 mg) before undergoing the primary PCI. All patients were subjected to general and local examination, laboratory investigations including CBC, lipid profile, CKMB, troponin, serum urea, creatinine and creatinine clearance (CrCl). Also, resting 12 ECG and coronary angiography were done. Summary of our results: • Serum creatinine was significantly higher after 48 hr compared to baseline in atorvastatin group. With no statistically differences were recorded between baseline and after 48hr in the rosuvastatin group. • Serum creatinine was significantly higher after 48 hr in the atorvastatin group compared to the rosuvastatin group. • The delta creatinine was significantly higher in the atorvastatin group compared to the rosuvastatin group. • Creatinine clearance (CrCl) was significantly lower after 48 hr compared to baseline in atorvastatin group • The CrCl level was insignificantly different between baseline and after 48hr in rosuvastatin group. • The contrast induced nephropathy was insignificantly different between atorvastatin and Rosuvastatin groups.