VA Boston Healthcare System, West Roxbury, MA 02132, USA.
J Am Coll Surg. 2013 Sep;217(3):452-60. doi: 10.1016/j.jamcollsurg.2013.04.030. Epub 2013 Jul 25.
Studies investigating lipid-lowering medication (LLM) use and LDL levels in coronary artery bypass grafting patients are limited.
The Veterans Affairs Randomized On/Off Bypass Trial's patient records were analyzed for LLM use and 1-year LDL levels. Mortality, acute MI (AMI), and repeat revascularization rates were compared at 1 year between patients with and without LLM at discharge. In addition, AMI, repeat revascularization, and graft patency were compared between patients that did and did not achieve a 1-year LDL target level of <100 mg/dL.
The LLM data were available for 86.4% (1,904 of 2,203) of patients. Rates of LLM use were 83.4% (1,316 of 1,577) at discharge and 90.0% (1,713 of 1,904) at 1 year. Patients discharged after coronary artery bypass grafting on LLMs had a significantly lower 1-year mortality rate (1.9% vs 5.4%; p < 0.01) than those not discharged on LLM, and 1-year AMI and repeat revascularization rates were not significantly different. Of the patients with 1-year LDL measurements, 69.4% (1,200 of 1,729) achieved an LDL target level of <100 mg/dL. No differences were seen in AMI, revascularization, or graft occlusion rates between patients who achieved target LDL levels and those who did not.
Rates of LLM use among veterans post-coronary artery bypass grafting are high. Discharge on LLM might be associated with improved intermediate-term survival. Patients who achieved an LDL target of <100 mg/dL at 1-year did not experience improved 1-year clinical outcomes or graft patency. Longer-term follow-up might reveal differences in cardiac outcomes related to achievement of target LDL levels.
研究降脂药物（LLM）的使用和接受冠状动脉旁路移植术患者的 LDL 水平的研究是有限的。
退伍军人事务部随机 ON/OFF 旁路试验的患者记录进行了分析，以了解 LLM 的使用情况和 1 年 LDL 水平。在出院时，比较了有和没有 LLM 的患者在 1 年内的死亡率、急性心肌梗死（AMI）和再次血运重建率。此外，比较了未达到和达到 LDL 目标水平<100mg/dL 的患者之间的 AMI、再次血运重建和移植物通畅率。
86.4%（2203 例中的 1904 例）患者的 LLM 数据可用。出院时 LLM 使用率为 83.4%（1577 例中的 1316 例），1 年后为 90.0%（1904 例中的 1713 例）。在出院时接受 LLM 治疗的接受冠状动脉旁路移植术的患者，1 年死亡率明显较低（1.9%对 5.4%；p<0.01），而 1 年 AMI 和再次血运重建率无显著差异。在有 1 年 LDL 测量值的患者中，69.4%（1729 例中的 1200 例）达到 LDL 目标水平<100mg/dL。在达到 LDL 目标水平的患者和未达到 LDL 目标水平的患者之间，AMI、血运重建或移植物闭塞率无差异。
接受冠状动脉旁路移植术后退伍军人使用 LLM 的比例较高。出院时使用 LLM 可能与改善中期生存率相关。在 1 年内达到 LDL 目标<100mg/dL 的患者，1 年内临床结局或移植物通畅率没有改善。长期随访可能会发现与 LDL 目标水平相关的心脏结局的差异。
