Ferrières Jean, Bataille Vincent, Leclercq Florence, Geslin Philippe, Ruidavets Jean-Bernard, Grollier Gilles, Bernard Paul, Cambou Jean-Pierre, Simon Tabassome, Danchin Nicolas
Cardiology department, CHU Rangueil, Toulouse, France.
Atherosclerosis. 2009 Jun;204(2):491-6. doi: 10.1016/j.atherosclerosis.2008.09.031. Epub 2008 Oct 8.
Early use of high-dose statins in acute coronary artery disease is controversial. Our aim was to use the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) to analyse patterns of statin prescription during the acute phase of myocardial infarction, and to identify factors associated with prescription strategies.
We analysed statin prescription in 2509 patients with an acute myocardial infarction enrolled at 223 hospitals in France who were enrolled in the FAST-MI study and survived to hospital discharge. Patients were subdivided into four groups: never prescribed statins (n=304); only prescribed statins at hospital discharge (n=293); prescribed statins in the first 48 h of hospitalization and at discharge (n=1318); prescribed statins before hospitalization, in the first 48 h of hospitalization and at discharge (n=594).
Multivariable analysis showed that the presence of notable coronary lesions was significantly associated with all three statin prescription categories (P<0.001). History of hypercholesterolaemia (P<0.001) and prescription of evidence-based therapies for myocardial infarction in the first 48 h of hospitalization (P<or=0.05) were significantly associated with statin prescription in the first 48 h and at discharge, and with continuation of statin prescription if patients were receiving statins before hospitalization. High doses of statins were prescribed rarely; only 20.2% of patients prescribed statins in the first 48 h of hospitalization and at discharge received atorvastatin 80 mg/day.
Use of statins by French cardiologists in the management of acute myocardial infarction is high, though still suboptimal. Outcomes may be improved by encouraging adherence to current guidelines, promoting the findings of clinical trials illustrating the benefits of intensive statin therapy, and reassessing professional practices in this setting.
急性冠状动脉疾病早期使用大剂量他汀类药物存在争议。我们的目的是利用法国急性ST段抬高型和非ST段抬高型心肌梗死注册研究（FAST-MI）分析心肌梗死急性期他汀类药物的处方模式，并确定与处方策略相关的因素。
我们分析了法国223家医院纳入FAST-MI研究并存活至出院的2509例急性心肌梗死患者的他汀类药物处方情况。患者分为四组：从未处方他汀类药物（n = 304）；仅在出院时处方他汀类药物（n = 293）；住院后48小时内及出院时处方他汀类药物（n = 1318）；住院前、住院后48小时内及出院时处方他汀类药物（n = 594）。
多变量分析显示，显著冠状动脉病变与所有三种他汀类药物处方类别均显著相关（P < 0.001）。高胆固醇血症病史（P < 0.001）以及住院后48小时内心肌梗死循证治疗的处方情况（P≤0.05）与住院后48小时内及出院时的他汀类药物处方显著相关，并且如果患者在住院前接受他汀类药物治疗，则与他汀类药物处方的持续情况显著相关。很少处方大剂量他汀类药物；仅20.2%在住院后48小时内及出院时处方他汀类药物的患者接受了每日80毫克阿托伐他汀治疗。
法国心脏病学家在急性心肌梗死管理中使用他汀类药物的比例较高，但仍未达最佳水平。通过鼓励遵循现行指南、推广说明强化他汀类药物治疗益处的临床试验结果以及重新评估此背景下的专业实践，可能会改善治疗结果。
