Marschner I C, Colquhoun D, Simes R J, Glasziou P, Harris P, Singh B B, Friedlander D, White H, Thompson P, Tonkin A
NHMRC Clinical Trials Center, University of Sydney, Australia.
J Am Coll Cardiol. 2001 Jul;38(1):56-63. doi: 10.1016/s0735-1097(01)01360-2.
We developed a prognostic strategy for quantifying the long-term risk of coronary heart disease (CHD) events in survivors of acute coronary syndromes (ACS).
Strategies for quantifying long-term risk of CHD events have generally been confined to primary prevention settings. The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study, which demonstrated that pravastatin reduces CHD events in ACS survivors with a broad range of cholesterol levels, enabled assessment of long-term prognosis in a secondary prevention setting.
Based on outcomes in 8,557 patients in the LIPID study, a multivariate risk factor model was developed for prediction of CHD death or nonfatal myocardial infarction. Prognostic indexes were developed based on the model, and low-, medium-, high- and very high-risk groups were defined by categorizing the prognostic indexes.
In addition to pravastatin treatment, the independently significant risk factors included: total and high density lipoprotein cholesterol, age, gender, smoking status, qualifying ACS, prior coronary revascularization, diabetes mellitus, hypertension and prior stroke. Pravastatin reduced coronary event rates in each risk level, and the relative risk reduction did not vary significantly between risk levels. The predicted five-year coronary event rates ranged from 5% to 19% for those assigned pravastatin and from 6.4% to 23.6% for those assigned placebo.
Long-term prognosis of ACS survivors varied substantially according to conventional risk factor profile. Pravastatin reduced coronary risk within all risk levels; however, absolute risk remained high in treated patients with unfavorable profiles. Our risk stratification strategy enables identification of ACS survivors who remain at very high risk despite statin therapy.
我们制定了一种预后策略，用于量化急性冠状动脉综合征（ACS）幸存者发生冠心病（CHD）事件的长期风险。
量化CHD事件长期风险的策略通常局限于一级预防环境。普伐他汀对缺血性疾病的长期干预（LIPID）研究表明，普伐他汀可降低胆固醇水平范围广泛的ACS幸存者的CHD事件发生率，从而能够在二级预防环境中评估长期预后。
基于LIPID研究中8557例患者的结局，开发了一种多变量风险因素模型，用于预测CHD死亡或非致命性心肌梗死。基于该模型制定了预后指标，并通过对预后指标进行分类来定义低、中、高和极高风险组。
除普伐他汀治疗外，独立的显著风险因素包括：总胆固醇和高密度脂蛋白胆固醇、年龄、性别、吸烟状况、符合条件的ACS、既往冠状动脉血运重建、糖尿病、高血压和既往中风。普伐他汀降低了每个风险水平的冠状动脉事件发生率，且风险降低的相对幅度在不同风险水平之间没有显著差异。接受普伐他汀治疗的患者预测的五年冠状动脉事件发生率为5%至19%，接受安慰剂治疗的患者为6.4%至23.6%。
ACS幸存者的长期预后根据传统风险因素情况有很大差异。普伐他汀在所有风险水平均降低了冠状动脉风险；然而，在具有不良风险特征的接受治疗患者中，绝对风险仍然很高。我们的风险分层策略能够识别出尽管接受他汀类药物治疗但仍处于极高风险的ACS幸存者。
