Skulec R, Linhart A, Hnátek T, Spundová H, Mrázek V, Bĕlohlávek J, Holm F, Aschermann M
II. interní klinika 1. lékarské fakulty UK a VFN, Praha.
Vnitr Lek. 2003 Apr;49(4):285-90.
Long-term statin therapy is the corner-stone in management of patients with coronary artery disease.
The aim of our study was to analyze the state of the statin therapy at patients undergoing percutaneous coronary intervention (PCI) and to determine predictors of long-term statin treatment.
We performed a retrospective study in 520 patients who underwent percutaneous coronary angioplasty in 2nd Dept. of Internal Medicine, 1st School of Medicine, Charles University, Prague during the year 2000. Data were collected from hospital records and from a mailed questionnaire.
The response rate was 61.9% and the average response time was 11.6 +/- 3.5 months after PCI. Long-term statin therapy was prescribed in 52.5%. In patients with hypercholesterolemia 67.1% were treated in comparison with 32.3% treated patients without this diagnosis (p < 0.0001). Patients aged 70 years and older were treated significantly less frequently then younger individuals (30.6% vs. 61.3%, p < 0.0001). Patients with a history of prior revascularization procedure were treated significantly more often then patients undergoing the first procedure (64.8% vs. 49.8%, p < 0.05). Multivariate logistic regression analysis was applied to detect significant predictors of long-term statin therapy. Only hypercholesterolemia and statin prescription at discharge were identified as independent positive predictors, whereas age > or = 70 years and male gender had negative predictive value.
By course of evidence-based medicine, patients who underwent PCI in our study are undertreated by statins. Statin treatment should be initiated in all patients treated by PCI with increased cardiovascular risk. Patients at defined risk for undertreatment are mainly older patients and men. The prescription of statin therapy at the time of hospital discharge appears to be a very effective tool to improve long-term statin therapy.
长期他汀类药物治疗是冠心病患者管理的基石。
我们研究的目的是分析接受经皮冠状动脉介入治疗（PCI）患者的他汀类药物治疗状况，并确定长期他汀治疗的预测因素。
我们对2000年在布拉格查理大学第一医学院内科第二科室接受经皮冠状动脉成形术的520例患者进行了回顾性研究。数据从医院记录和邮寄问卷中收集。
回复率为61.9%，PCI术后平均回复时间为11.6±3.5个月。52.5%的患者接受了长期他汀类药物治疗。高胆固醇血症患者中67.1%接受了治疗，而无此诊断的治疗患者为32.3%（p<0.0001）。70岁及以上患者的治疗频率明显低于年轻患者（30.6%对61.3%，p<0.0001）。有既往血运重建手术史的患者比首次接受手术的患者治疗频率明显更高（64.8%对49.8%，p<0.05）。应用多因素逻辑回归分析来检测长期他汀治疗的显著预测因素。仅高胆固醇血症和出院时他汀类药物处方被确定为独立的阳性预测因素，而年龄≥70岁和男性具有负预测价值。
根据循证医学的进程，我们研究中接受PCI的患者他汀类药物治疗不足。所有接受PCI且心血管风险增加的患者均应启动他汀治疗。治疗不足风险明确的患者主要是老年患者和男性。出院时他汀类药物治疗的处方似乎是改善长期他汀治疗的非常有效的工具。
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