经皮冠状动脉介入治疗后他汀类药物的有益作用。
Beneficial effects of statins after percutaneous coronary intervention.
作者信息
Zhang Zhi-Jiang, Marroquin Oscar C, Weissfeld Joel L, Stone Roslyn A, Mulukutla Suresh R, Williams David O, Selzer Faith, Kip Kevin E
机构信息
Department of Epidemiology, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Eur J Cardiovasc Prev Rehabil. 2009 Aug;16(4):445-50. doi: 10.1097/HJR.0b013e32832a4e3b.
BACKGROUND
Evidence about the efficacy of statin treatment among patients after percutaneous coronary intervention (PCI) is very limited. The rapid advancement in PCI technology and near universal use of adjunctive cardioprotective medications make it necessary to formally assess the effect of statin therapy on cardiac events after PCI.
DESIGN
This was a multicenter prospective cohort study.
METHODS
Patients who received stent implantation and survived to hospital discharge from the National Heart, Lung, and Blood Institute Dynamic Registry from 2004 to 2006 formed the study cohort. Patients with cardiogenic shock, in-hospital adverse events [including myocardial infarction and coronary artery bypass graft surgery (CABG)], liver disease, renal disease, alcoholism, or drug abuse were excluded. The occurrences of death, CABG, and repeat PCI, and repeat revascularization were collected over 1-year follow-up.
RESULTS
Of the 3227 patients evaluated, 2737 (85%) were prescribed a statin at discharge. By 1-year follow-up, incident events were 98 deaths, 44 CABG, 290 repeat PCI procedures, and 328 repeat revascularizations. After propensity score adjustment, postdischarge statin therapy was associated with lower risks of death [hazard ratio (HR): 0.58, 95% confidence interval (CI): 0.36-0.93, P = 0.02], CABG (HR: 0.49, 95% CI: 0.24-1.00, P = 0.05), and repeat revascularization (HR: 0.74, 95% CI: 0.56-1.00, P = 0.05).
CONCLUSION
These results support the routine use of statin therapy after PCI.
背景
关于经皮冠状动脉介入治疗（PCI）后患者他汀类药物治疗疗效的证据非常有限。PCI技术的迅速发展以及辅助性心脏保护药物的几乎普遍使用，使得有必要正式评估他汀类药物治疗对PCI后心脏事件的影响。
设计
这是一项多中心前瞻性队列研究。
方法
2004年至2006年从美国国立心肺血液研究所动态登记处接受支架植入并存活至出院的患者组成研究队列。排除心源性休克、住院不良事件[包括心肌梗死和冠状动脉搭桥术（CABG）]、肝病、肾病、酗酒或药物滥用患者。在1年随访期间收集死亡、CABG、重复PCI以及重复血运重建的发生情况。
结果
在评估的3227例患者中，2737例（85%）出院时开具了他汀类药物。到1年随访时，发生的事件有98例死亡、44例CABG、290例重复PCI手术以及328例重复血运重建。在倾向评分调整后，出院后他汀类药物治疗与较低的死亡风险[风险比（HR）：0.58，95%置信区间（CI）：0.36 - 0.93，P = 0.02]、CABG（HR：0.49，95% CI：0.24 - 1.00，P = 0.05）和重复血运重建（HR：0.74，95% CI：0.56 - 1.00，P = 0.05）相关。
结论
这些结果支持PCI后常规使用他汀类药物治疗。
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