大血管手术患者中他汀类药物治疗强度与心肌缺血、肌钙蛋白T释放及临床心脏结局的关系

Intensity of statin therapy in relation to myocardial ischemia, troponin T release, and clinical cardiac outcome in patients undergoing major vascular surgery.

作者信息

Feringa Harm H H, Schouten Olaf, Karagiannis Stefanos E, Brugts Jasper, Elhendy Abdou, Boersma Eric, Vidakovic Radosav, van Sambeek Marc R H M, Noordzij Peter G, Bax Jeroen J, Poldermans Don

机构信息

Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

J Am Coll Cardiol. 2007 Oct 23;50(17):1649-56. doi: 10.1016/j.jacc.2007.06.046.

DOI:10.1016/j.jacc.2007.06.046

PMID:17950146

Abstract

OBJECTIVES

This study sought to examine whether higher statin doses and lower low-density lipoprotein (LDL) cholesterol are associated with improved cardiac outcome in vascular surgery patients.

BACKGROUND

Statins may have cardioprotective effects during major vascular surgery.

METHODS

In a prospective study of 359 vascular surgery patients, statin dose and cholesterol levels were recorded preoperatively. Myocardial ischemia and heart rate variability were assessed by 72-h 12-lead electrocardiography starting 1 day before to 2 days after surgery. Troponin T was measured on postoperative day 1, 3, 7, and before discharge. Cardiac events included cardiac death or nonfatal Q-wave myocardial infarction at 30 days and follow-up (mean 2.3 years).

RESULTS

Perioperative myocardial ischemia, troponin T release, 30-day events, and late cardiac events occurred in 29%, 23%, 4%, and 18%, respectively. In multivariate analysis, lower LDL cholesterol (per 10 mg/dl) correlated with lower myocardial ischemia (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80 to 0.95), troponin T release (OR 0.89, 95% CI 0.82 to 0.96), and 30-day (OR 0.89, 95% CI 0.78 to 1.00) and late cardiac events (hazard ratio 0.91, 95% CI 0.84 to 0.96). Higher statin doses (per 10% of maximum recommended dose) correlated with lower myocardial ischemia (OR 0.85, 95% CI 0.76 to 0.93), troponin T release (OR 0.84, 95% CI 0.76 to 0.93), and 30-day (OR 0.62, 95% CI 0.40 to 0.96) and late cardiac events (hazard ratio 0.76, 95% CI 0.65 to 0.89), even after adjusting for LDL cholesterol. Significantly higher perioperative heart rate variability was observed in patients with higher statin doses.

CONCLUSIONS

Higher statin doses and lower LDL cholesterol correlate with lower perioperative myocardial ischemia, perioperative troponin T release, and 30-day and late cardiac events in major vascular surgery.

摘要

目的

本研究旨在探讨更高剂量的他汀类药物和更低的低密度脂蛋白（LDL）胆固醇水平是否与血管外科手术患者改善的心脏结局相关。

背景

他汀类药物在重大血管手术期间可能具有心脏保护作用。

方法

在一项对359例血管外科手术患者的前瞻性研究中，术前记录他汀类药物剂量和胆固醇水平。从手术前1天至手术后2天，通过72小时12导联心电图评估心肌缺血和心率变异性。在术后第1天、第3天、第7天及出院前测量肌钙蛋白T。心脏事件包括30天及随访期（平均2.3年）内的心脏死亡或非致命性Q波心肌梗死。

结果

围手术期心肌缺血、肌钙蛋白T释放、30天事件和晚期心脏事件的发生率分别为29%、23%、4%和18%。在多变量分析中，更低的LDL胆固醇水平（每降低10mg/dl）与更低的心肌缺血（比值比[OR]0.87，95%置信区间[CI]0.80至0.95）、肌钙蛋白T释放（OR 0.89，95%CI 0.82至0.96）、30天事件（OR 0.89，95%CI 0.78至1.00）和晚期心脏事件（风险比0.91，95%CI 0.84至0.96）相关。更高剂量的他汀类药物（每增加最大推荐剂量的10%）与更低的心肌缺血（OR 0.85，95%CI 0.76至0.93）、肌钙蛋白T释放（OR 0.84，95%CI 0.76至0.93）、30天事件（OR 0.62，95%CI 0.40至0.96）和晚期心脏事件（风险比0.76，95%CI 0.65至0.89）相关，即使在调整LDL胆固醇水平后也是如此。他汀类药物剂量更高的患者围手术期心率变异性显著更高。