他汀类药物与危重肢体缺血患者的死亡率、主要不良心血管事件和免于截肢的生存之间的关系。
Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia.
机构信息
School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
出版信息
J Am Coll Cardiol. 2014 Feb 25;63(7):682-690. doi: 10.1016/j.jacc.2013.09.073. Epub 2013 Dec 4.
OBJECTIVES
The aim of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients.
BACKGROUND
CLI is an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain.
METHODS
We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins.
RESULTS
Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL.
CONCLUSIONS
Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
目的
本研究旨在确定在患有严重肢体缺血（CLI）的患者中，使用他汀类药物与主要不良心脑血管事件（MACCE）和免于截肢的生存率之间的关联。
背景
CLI 是外周动脉疾病的一种晚期形式，与无法愈合的动脉溃疡以及高比率的 MACCE 和主要截肢相关。尽管他汀类药物被推荐用于外周动脉疾病的二级预防，但它们在 CLI 中的疗效尚不确定。
方法
我们回顾了 2006 年至 2012 年间接受诊断性血管造影或治疗性血管内介入治疗的 380 例 CLI 患者。采用倾向评分和治疗反概率加权来调整接受和不接受他汀类药物治疗的患者之间的基线差异。
结果
246 例（65%）患者开具了他汀类药物。接受他汀类药物治疗的患者的血清低密度脂蛋白（LDL）水平较低（75±28mg/dl 比 96±40mg/dl，p<0.001）。接受他汀类药物治疗的患者基线合并症更多，包括糖尿病、冠状动脉疾病和高血压，以及更广泛的下肢疾病（所有 p 值均<0.05）。在倾向评分加权后，他汀类药物治疗与较低的 1 年 MACCE（中风、心肌梗死或死亡；风险比[HR]：0.53；95%置信区间[CI]：0.28 至 0.99）、死亡率（HR：0.49，95%CI：0.24 至 0.97）和主要截肢或死亡（HR：0.53，95%CI：0.35 至 0.98）发生率相关。他汀类药物治疗还与接受膝下血管成形术的患者的病变通畅率提高相关。LDL 水平>130mg/dl 的患者发生 MACCE 和死亡率的 HR 高于 LDL 水平较低的患者。
结论
他汀类药物与 CLI 患者的死亡率和 MACCE 发生率降低以及免于截肢的生存率提高相关。
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