Flaker G C, Warnica J W, Sacks F M, Moyé L A, Davis B R, Rouleau J L, Webel R R, Pfeffer M A, Braunwald E
University of Missouri, Columbia, USA.
J Am Coll Cardiol. 1999 Jul;34(1):106-12. doi: 10.1016/s0735-1097(99)00145-x.
This analysis was carried out to determine if revascularized patients derive benefit from the 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor pravastatin.
The HMG-CoA reductase inhibitors result in substantial reductions in serum cholesterol and stabilization of atherosclerotic plaques in patients with coronary artery disease.
Pravastatin was found to reduce clinical cardiovascular events in the Cholesterol and Recurrent Events (CARE) trial consisting of 4,159 patients with a documented myocardial infarction and an average cholesterol level (mean 209 mg/dl and all <240 mg/dl). A total of 2,245 patients underwent coronary revascularization before randomization including 1,154 patients with percutaneous transluminal coronary angioplasty (PTCA) alone, 876 patients with coronary artery bypass graft (CABG) alone, and 215 patients with both procedures. Clinical events in revascularized patients were compared between patients on placebo and on pravastatin.
In the 2,245 patients who had undergone revascularization, the primary endpoint of coronary heart disease death or nonfatal myocardial infarction (MI) was reduced by 4.1% with pravastatin (relative risk [RR] reduction 36%, 95% confidence interval [CI] 17 to 51, p = 0.001). Fatal or nonfatal MI was reduced by 3.3% (RR reduction 39%, 95% CI 16 to 55, p = 0.002), postrandomization repeat revascularization was reduced by 2.6% (RR reduction 18%, 95% CI 1 to 33, p = 0.068) and stroke was reduced by 1.5% (RR reduction 39%, 95% CI 3 to 62, p = 0.037) with pravastatin. Pravastatin was beneficial in both the 1,154 PTCA patients and in the 1,091 CABG patients who had undergone revascularization before randomization.
Pravastatin reduced clinical events in revascularized postinfarction patients with average cholesterol levels. This therapy was well tolerated and its use should be considered in most patients following coronary revascularization.
进行此项分析以确定血管再通患者是否能从3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂普伐他汀中获益。
HMG-CoA还原酶抑制剂可使冠心病患者的血清胆固醇大幅降低，并使动脉粥样硬化斑块稳定。
在胆固醇与再发事件（CARE）试验中，普伐他汀被发现可减少临床心血管事件，该试验纳入了4159例有心肌梗死记录且平均胆固醇水平（平均209mg/dl且均<240mg/dl）的患者。共有2245例患者在随机分组前接受了冠状动脉血运重建，其中1154例仅接受经皮冠状动脉腔内血管成形术（PTCA），876例仅接受冠状动脉旁路移植术（CABG），215例接受了两种手术。比较了接受安慰剂和普伐他汀治疗的血管再通患者的临床事件。
在2245例接受血运重建的患者中，普伐他汀使冠心病死亡或非致死性心肌梗死（MI）的主要终点降低了4.1%（相对危险度[RR]降低36%，95%置信区间[CI]17至51，p = 0.001）。致死性或非致死性MI降低了3.3%（RR降低39%，95%CI 16至55，p = 0.002），随机分组后再次血运重建降低了2.6%（RR降低18%，95%CI 1至33，p = 0.068），中风降低了1.5%（RR降低39%
