他汀类药物预处理与冠心病患者的临床表现模式。

Statin pretreatment and presentation patterns in patients with coronary artery disease.

出版信息

Cardiol J. 2013;20(1):52-8. doi: 10.5603/CJ.2013.0009.

DOI:10.5603/CJ.2013.0009

Abstract

BACKGROUND

Knowledge on the impact of pretreatment statin therapy on presentation of patients with coronary artery disease (CAD) is incomplete. The aim of this study was to investigate the impact of statin pretreatment on presentation patterns of patients with CAD.

METHODS

The study included 12,989 consecutive patients with CAD who underwent coronary angiography. The primary outcome was presentation as stable angina or acute coronary syndrome (ACS) according to statin pretreatment.

RESULTS

At the time of presentation, 8147 (62.7%) patients were receiving statins and 4842 (37.3%) patients were not receiving statins. Presentation pattern in patients receiving statins vs. those not receiving statins was: stable angina in 5939 (72.9%) vs. 2102 (43.4%) patients; odds ratio (OR) = 3.50, 95% confidence interval (CI) 3.25-3.78; p < 0.001; unstable angina in 1435 (17.6%) vs. 1011 (20.9%) patients; OR = 0.81, 95% CI 0.74-0.89; p < 0.001; non- -ST-segment elevation myocardial infarction (NSTEMI) in 463 (5.7%) vs. 505 (10.4%) patients; OR = 0.52, 95% CI 0.45-0.59; p < 0.001; and ST-segment elevation myocardial infarction (STEMI) in 310 (3.8%) vs. 1224 (25.3%) patients; OR = 0.11, 95% CI 0.10-0.13; p < 0.001. Gensini score (median [25th to 75th percentiles]) was significantly higher in patients on statins presenting with stable angina (26.5 [13.0-59.5] vs. 21.0 [10.5-47.4]; p < 0.001) or ACS (39.3 [17.5-77.0] vs. 37.0 [18.0-64.0]; p = 0.001). In multivariable analysis, statin therapy was an independent correlate of reduced presentation with ACS (adjusted OR = 0.35 [0.32-0.39]; p < 0.001) or STEMI (adjusted OR = 0.18 [0.16-0.22]; p < 0.001).

CONCLUSIONS

Despite having a higher coronary atherosclerotic burden, patients with CAD on statin therapy have reduced odds for presentation with ACS and STEMI compared to patients not receiving statins.

摘要

背景

关于预处理他汀类药物治疗对冠状动脉疾病（CAD）患者表现的影响的知识并不完整。本研究的目的是调查他汀类药物预处理对 CAD 患者表现模式的影响。

方法

本研究纳入了 12989 例连续接受冠状动脉造影的 CAD 患者。主要结局是根据他汀类药物预处理将患者表现为稳定型心绞痛或急性冠状动脉综合征（ACS）。

结果

在就诊时，8147 例（62.7%）患者正在服用他汀类药物，4842 例（37.3%）患者未服用他汀类药物。服用他汀类药物的患者与未服用他汀类药物的患者的表现模式为：稳定型心绞痛 5939 例（72.9%）比 2102 例（43.4%）；优势比（OR）=3.50，95%置信区间（CI）3.25-3.78；p<0.001；不稳定型心绞痛 1435 例（17.6%）比 1011 例（20.9%）；OR=0.81，95%CI 0.74-0.89；p<0.001；非 ST 段抬高心肌梗死（NSTEMI）463 例（5.7%）比 505 例（10.4%）；OR=0.52，95%CI 0.45-0.59；p<0.001；ST 段抬高心肌梗死（STEMI）310 例（3.8%）比 1224 例（25.3%）；OR=0.11，95%CI 0.10-0.13；p<0.001。服用他汀类药物的稳定型心绞痛（26.5[13.0-59.5]比 21.0[10.5-47.4]；p<0.001）或 ACS（39.3[17.5-77.0]比 37.0[18.0-64.0]；p=0.001）患者的 Gensini 评分（中位数[25 至 75 分位数]）明显更高。多变量分析显示，他汀类药物治疗是 ACS（调整后的 OR=0.35[0.32-0.39]；p<0.001）或 STEMI（调整后的 OR=0.18[0.16-0.22]；p<0.001）发生率降低的独立相关因素。