Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
Clin Cardiol. 2012 Apr;35(4):211-8. doi: 10.1002/clc.20984. Epub 2011 Nov 18.
Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI).
The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels.
Between November 2005 and January 2008, 6866 statin-naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations.
The 6-month MACE and mortality showed a U-shaped curve, with the lowest rate at 114-122 mg/dL. Propensity scores for statin use were calculated for patients with LDL-C ≤ 113 mg/dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6-month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646-1.111, P = 0.230), whereas the 6-month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539-0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL-C ≤ 105 mg/dL, not only the 6-month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700-1.277, P = 0.713) but also the 6-month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566-1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group).
The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.
关于急性心肌梗死（AMI）患者接受他汀类药物治疗的低密度脂蛋白胆固醇（LDL-C）的最低阈值水平知之甚少。
本研究的目的是探讨他汀类药物治疗 LDL-C 水平较低的 MI 后患者的短期获益。
2005 年 11 月至 2008 年 1 月，从韩国 AMI 登记处选择了 6866 名未使用他汀类药物的患者。主要不良心脏事件（MACE）定义为死亡、再发心肌梗死和血运重建的复合事件。
6 个月时 MACE 和死亡率呈 U 型曲线，最低发生率为 114-122mg/dL。为 LDL-C≤113mg/dL 的患者计算了他汀类药物使用的倾向评分，并将接受他汀类药物治疗的患者（他汀类药物使用者，n=1031）与未接受他汀类药物治疗的患者（他汀类药物非使用者，n=1031）进行匹配。他汀类药物使用者和他汀类药物非使用者之间 6 个月时的 MACE 无显著差异（9.4%vs11.0%；风险比[HR]：0.847，95%置信区间[CI]：0.646-1.111，P=0.230），但他汀类药物使用者的 6 个月死亡率显著较低（7.2%vs9.7%；HR：0.728，95%CI：0.539-0.984，P=0.039）。然而，当在 LDL-C≤105mg/dL 的患者中重复分析时，不仅 6 个月时的 MACE（9.5%vs9.9%；HR：0.945，95%CI：0.700-1.277，P=0.713），而且 6 个月时的死亡率（7.0%vs8.7%；HR：0.793，95%CI：0.566-1.111，P=0.177）在他汀类药物使用者和他汀类药物非使用者之间也无显著差异（每组 n=876）。
在 AMI 患者 LDL-C 低于某一水平时，他汀类药物治疗的有益作用似乎消失。
