他汀类药物对颈动脉内膜切除术后的长期再狭窄和心血管事件有影响。

Statins influence long term restenosis and cardiovascular events following carotid endarterectomy.

作者信息

Avgerinos Efthymios D, Kakisis John D, Moulakakis Konstantinos G, Giannakopoulos Triantafillos G, Sfyroeras George, Antonopoulos Constantinos N, Kadoglou Nikolaos P, Liapi Christos D

机构信息

Department of Vascular Surgery, Attikon University Hospital, Athens University Medical School, 1 Rimini Street, Haidari, Athens124 62, Greece.

出版信息

Curr Vasc Pharmacol. 2015;13(2):239-47. doi: 10.2174/15701611113119990130.

DOI:10.2174/15701611113119990130

PMID:23790064

Abstract

OBJECTIVE

To evaluate the impact of statins on carotid restenosis (CR) >50% and future cardiovascular events (CVE), in patients undergoing carotid endarterectomy (CEA).

METHODS

570 consecutive patients (656 CEAs) operated between 1990 and 2009, were included in this retrospective study. The study cohort was followed for an average of 82 months (median 80, range 12- 180 months). Endpoints were the development of CR >50%, the occurrence of CVE (myocardial infarction, stroke) and overall mortality. Kaplan-Meier curves and Cox regression models were used to assess outcomes.

RESULTS

92 restenosis events were recorded. Freedom from restenosis >50% at 5, 10 and 15 years of follow-up was 92, 82 and 69%, respectively. Compared with statin-receivers, statin-free patients had a significantly higher 15-year restenosis rate (41 vs 10%; P = .001), a significantly higher CVE rate (49 vs 14%; P = .001) and a significantly higher mortality rate (24 vs 18%; P = .034). Adjusting for other covariates statins were independently associated with lower restenosis rate (hazard ratio [HR], 0.52; 95% CI, 0.31-0.88; P= .016), cardiovascular events (HR, 0.40; 95% CI, 0.26-0.61; P < 0.001) and long-term mortality (HR, 0.56; 95% CI, 0.33-0.95; P = .032).

CONCLUSION

Statins not only reduce cardiovascular events and mortality but may also have an important effect on the anatomic durability of CEA. These data support the use of statins in patients with carotid stenosis undergoing CEA.

摘要

目的

评估他汀类药物对接受颈动脉内膜切除术（CEA）患者中颈动脉再狭窄（CR）>50%及未来心血管事件（CVE）的影响。

方法

本回顾性研究纳入了1990年至2009年间连续接受手术的570例患者（656次CEA手术）。研究队列平均随访82个月（中位数80个月，范围12 - 180个月）。终点指标为CR>50%的发生、CVE（心肌梗死、中风）的发生及总死亡率。采用Kaplan-Meier曲线和Cox回归模型评估结果。

结果

记录到92例再狭窄事件。随访5年、10年和15年时无>50%再狭窄的比例分别为92%、82%和69%。与接受他汀类药物治疗的患者相比，未接受他汀类药物治疗的患者15年再狭窄率显著更高（41%对10%；P = .001），CVE发生率显著更高（49%对14%；P = .001），死亡率也显著更高（24%对18%；P = .034）。在对其他协变量进行校正后，他汀类药物与较低的再狭窄率（风险比[HR]，0.52；95%置信区间[CI]，0.31 - 0.88；P = .016）、心血管事件（HR，0.40；95% CI，0.26 - 0.61；P < 0.001）及长期死亡率（HR，0.56；95% CI，0.33 - 0.95；P = .032）独立相关。