Department of Cardiology, I. Horbachevsky Medical University, Ternopil, Ukraine. roman
Clin Cardiol. 2010 Feb;33(2):E15-9. doi: 10.1002/clc.20610.
Statins prevent recurrent ischemic coronary events after acute coronary syndrome (ACS) and improve cardiovascular outcome of patients with peripheral artery disease.
We sought to evaluate the interrelationship between statin use, phenotype of carotid plaques as assessed by ultrasound, and outcome of patients with ACS and concomitant carotid disease.
A total of 337 consecutive patients with ACS were assessed by coronary angiography and Doppler ultrasound of the carotid arteries and followed up for a median period of 19 months.
Carotid plaques were detected in 144 (42%) patients. Of these patients, 99 (69%) had echogenic carotid plaques and 45 (31%) had echolucent plaques. The groups did not differ significantly with regard to the lipid profiles, the prevalence of risk factors, and 1-vessel, 2-vessel, or 3-vessel coronary artery disease. During follow-up, 227 (67%) patients were receiving statins. We observed 14 cardiac deaths and 17 myocardial infarctions. After adjustment for treatment strategy (medical therapy or myocardial revascularization), patients with echolucent carotid plaques receiving statin therapy (n = 32, 71%) showed a better event-free survival than did patients with echolucent plaques not treated with statins (log-rank P = .038). In patients with echogenic carotid plaques, the benefit of statin therapy on event-free survival was less evident (log-rank P = .56).
In patients with ACS and echolucent carotid plaques, statin therapy is associated with better event-free survival, while in patients with ACS and echogenic carotid plaques no clear benefit of statins is observed.
他汀类药物可预防急性冠脉综合征（ACS）后再次发生缺血性冠脉事件，并改善外周动脉疾病患者的心血管结局。
我们旨在评估他汀类药物的使用、超声评估的颈动脉斑块表型与 ACS 合并颈动脉疾病患者的结局之间的相互关系。
共对 337 例连续 ACS 患者进行了冠状动脉造影和颈动脉多普勒超声检查，并进行了中位数为 19 个月的随访。
144 例（42%）患者发现颈动脉斑块。其中，99 例（69%）为回声斑块，45 例（31%）为低回声斑块。两组在血脂谱、危险因素患病率以及单支、双支或三支冠状动脉疾病方面无显著差异。随访期间，227 例（67%）患者正在服用他汀类药物。我们观察到 14 例心脏死亡和 17 例心肌梗死。在校正治疗策略（药物治疗或血运重建）后，接受他汀类药物治疗的低回声颈动脉斑块患者（n = 32，71%）与未接受他汀类药物治疗的低回声颈动脉斑块患者（log-rank P =.038）相比，无事件生存率更好。在回声斑块患者中，他汀类药物治疗对无事件生存率的获益不太明显（log-rank P =.56）。
在 ACS 合并低回声颈动脉斑块患者中，他汀类药物治疗与更好的无事件生存率相关，而在 ACS 合并回声斑块患者中，他汀类药物无明显获益。
