Gröschel Klaus, Ernemann Ulrike, Schulz Jörg B, Nägele Thomas, Terborg Christoph, Kastrup Andreas
Department of Neurology, University of Tübingen, Tübingen, Germany.
Radiology. 2006 Jul;240(1):145-51. doi: 10.1148/radiol.2401050603.
To retrospectively determine if preprocedural statin treatment is associated with a reduction of cardiovascular events after carotid angioplasty and stent placement (CAS) in patients with symptomatic carotid stenosis.
A study resulting in a prospective database was approved by the institutional ethics review board; written informed consent was obtained. The approval and informed consent included future retrospective analysis. Consecutive patients (n = 180) from the prospective database underwent CAS for high-grade symptomatic carotid disease. The frequency of cardiovascular complications (composite of stroke, myocardial infarction, and death within 30 days after CAS) between 127 patients without preprocedural statin treatment and that of 53 patients with preprocedural statin treatment at CAS were compared with chi2 and multivariate logistic regression analysis.
The overall 30-day myocardial infarction rate was two of 180 (1%) patients, the minor stroke rate was 16 of 180 (9%) patients, the major stroke rate was one of 180 (0.5%) patients, and the death rate was two of 180 (1%) patients. The incidence of cardiovascular events (composite of stroke, myocardial infarction, and death within 30 days after CAS) was significantly different between patients with preprocedural treatment (4%) and those without preprocedural statin treatment (15%) (P < .05). These higher complication rates among patients without preprocedural statin treatment were not mediated by adjustment for age, sex, other baseline characteristics, degree of carotid stenosis, use of cerebral protection devices, or the year in which CAS was performed.
Preprocedural statin therapy appears to reduce the incidence of stroke, myocardial infarction, and death within 30 days after CAS. Future prospective randomized trials are warranted to further assess this potential protective effect of statin drugs during carotid interventions.
回顾性确定症状性颈动脉狭窄患者在颈动脉血管成形术和支架置入术（CAS）前使用他汀类药物治疗是否与心血管事件减少相关。
一项产生前瞻性数据库的研究经机构伦理审查委员会批准；获得了书面知情同意书。批准和知情同意包括未来的回顾性分析。前瞻性数据库中的连续患者（n = 180）因重度症状性颈动脉疾病接受了CAS。采用卡方检验和多因素逻辑回归分析，比较了127例未进行术前他汀类药物治疗的患者与53例进行CAS术前他汀类药物治疗的患者的心血管并发症（CAS术后30天内的卒中、心肌梗死和死亡的综合情况）发生频率。
总的30天内心肌梗死发生率为180例患者中的2例（1%），轻度卒中发生率为180例患者中的16例（9%），重度卒中发生率为180例患者中的1例（0.5%），死亡率为180例患者中的2例（1%）。术前接受治疗的患者与未接受术前他汀类药物治疗的患者相比，心血管事件（CAS术后30天内的卒中、心肌梗死和死亡的综合情况）发生率有显著差异（4% 对15%）（P <.05）。未进行术前他汀类药物治疗的患者中较高的并发症发生率，在对年龄、性别、其他基线特征、颈动脉狭窄程度、脑保护装置的使用或进行CAS的年份进行校正后并未得到改善。
术前他汀类药物治疗似乎可降低CAS术后30天内的卒中、心肌梗死和死亡发生率。未来有必要进行前瞻性随机试验，以进一步评估他汀类药物在颈动脉介入治疗期间的这种潜在保护作用。
