Department of Epidemiology, School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
Pharmacol Res. 2010 Apr;61(4):316-20. doi: 10.1016/j.phrs.2009.11.004. Epub 2009 Nov 14.
Recent prospective cohort studies have shown that patients discharged on statins after percutaneous coronary intervention (PCI) are at lower risks of repeat revascularization and mortality when compared to those not on statins after discharge. However, few randomized clinical trials among post-PCI patients confirmed these beneficial effects. It is needed to evaluate the effects of post-procedural statin therapy on individual clinical outcomes to facilitate the further investigation on identifying the underlying mechanism(s). A meta-analysis of randomized clinical trials was conducted to examine the effects of statin therapy initiated after coronary angioplasty on repeat revascularization, all-cause mortality and myocardial infarction (MI). From relevant reports on Medline (from inception to October 2009), six randomized clinical trials comprising 2979 patients were included. Relative risks were evaluated for pooled data via random effect models. Compared with controls, post-PCI statin therapy was associated with a significantly decreased risk of repeat revascularization (risk ratio (RR)=0.73, 95% confidence interval (CI), 0.55-0.98, p=0.04), nonsignificantly decreased risks of all-cause mortality (RR=0.88, 95% CI, 0.35-2.21, p=0.79), MI (RR=0.76, 95% CI, 0.49-1.18, p=0.23), and target lesion or target vessel revascularization (RR=0.58, 95% CI, 0.24-1.39, p=0.22). In conclusion, statin therapy after PCI can reduce the risk of repeat revascularization. Further investigation is needed to identify the underlying mechanism(s).
近期前瞻性队列研究表明，与出院后未服用他汀类药物的患者相比，经皮冠状动脉介入治疗（PCI）后服用他汀类药物的患者再次血运重建和死亡的风险较低。然而，在 PCI 后患者中进行的随机临床试验证实了这些有益效果。需要评估术后他汀类药物治疗对个体临床结局的影响，以促进对潜在机制的进一步研究。对随机临床试验进行了荟萃分析，以评估经皮冠状动脉成形术后开始他汀类药物治疗对再次血运重建、全因死亡率和心肌梗死（MI）的影响。从 Medline 的相关报道（从成立到 2009 年 10 月）中，纳入了 6 项包括 2979 例患者的随机临床试验。通过随机效应模型评估汇总数据的相对风险。与对照组相比，PCI 后他汀类药物治疗与再次血运重建风险显著降低相关（风险比（RR）=0.73，95%置信区间（CI），0.55-0.98，p=0.04），全因死亡率（RR）显著降低无统计学意义=0.88，95%CI，0.35-2.21，p=0.79）、MI（RR=0.76，95%CI，0.49-1.18，p=0.23）和靶病变或靶血管血运重建（RR=0.58，95%CI，0.24-1.39，p=0.22）。总之，PCI 后他汀类药物治疗可降低再次血运重建的风险。需要进一步研究以确定潜在的机制。
