Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, , Dundee, UK.
Heart. 2014 Jun;100(11):867-72. doi: 10.1136/heartjnl-2013-304678. Epub 2014 Feb 19.
To determine all-cause mortality in patients with a first myocardial infarct who were treated with simvastatin compared with high-potency statin and simvastatin/ezetimibe combination.
Despite statin use, residual cardiovascular risk remains. Therapeutic options include more potent statins or addition of ezetimibe. There is no clinical outcome data on the use of ezetimibe in such patients.
Retrospective longitudinal study using the United Kingdom General Practice Research Database. Patients who had survived 30 days after their first acute myocardial infarct (AMI), had not received prior statin or ezetimibe therapy and were started on a statin within 30 days of AMI were included. Three groups were identified according to their follow-up: (i) simvastatin monotherapy; (ii) high-potency statin group (patients who started on simvastatin and switched to atorvastatin or rosuvastatin); and (iii) ezetimibe/statin combination group (patients who received ezetimibe in addition to statin).
9597 patients (57% male, mean age of 65 ± 13 years) matched study criteria: simvastatin (n=6990 (72.8%)); high-potency statin (n=1883, (19.6%)); and ezetimibe/statin combination (n=724 (7.5%)). During a mean follow-up of 3.2 years, there were 1134 (12%) deaths. In the multivariate proportional hazards model, the adjusted HR for high-potency statin and ezetimibe group were 0.72 (95% CI 0.59 to 0.88, p<0.001) and 0.96 (95% CI 0.64 to 1.43, p=0.85), respectively. A similar result was also obtained in the propensity score analysis that took into account covariates that predicted drug treatment groups.
Patients switched to a high-potency statin had a significantly reduced mortality compared with simvastatin monotherapy. There was no observed mortality benefit in the ezetimibe group.
比较辛伐他汀治疗首发心肌梗死患者与高强度他汀和辛伐他汀/依折麦布联合治疗的全因死亡率。
尽管使用了他汀类药物，但仍存在残余心血管风险。治疗选择包括更有效的他汀类药物或添加依折麦布。目前尚无关于此类患者使用依折麦布的临床结局数据。
采用英国全科医生研究数据库进行回顾性纵向研究。入选标准为：首次急性心肌梗死（AMI）后存活 30 天以上、未接受过他汀类药物或依折麦布治疗且在 AMI 后 30 天内开始使用他汀类药物的患者。根据随访情况将患者分为三组：（i）辛伐他汀单药治疗组；（ii）高强度他汀组（患者开始使用辛伐他汀，后换用阿托伐他汀或瑞舒伐他汀）；（iii）依折麦布/他汀类药物联合治疗组（患者在接受他汀类药物治疗的同时加用依折麦布）。
9597 例患者（57%为男性，平均年龄 65±13 岁）符合研究标准：辛伐他汀组（n=6990，占 72.8%）；高强度他汀组（n=1883，占 19.6%）；依折麦布/他汀类药物联合治疗组（n=724，占 7.5%）。在平均 3.2 年的随访期间，共有 1134 例（12%）患者死亡。在多变量比例风险模型中，高强度他汀和依折麦布联合治疗组的调整后 HR 分别为 0.72（95%CI 0.59 至 0.88，p<0.001）和 0.96（95%CI 0.64 至 1.43，p=0.85）。在考虑到预测药物治疗组的协变量的倾向评分分析中也得到了类似的结果。
与辛伐他汀单药治疗相比，换用高强度他汀类药物的患者死亡率显著降低。依折麦布组未观察到死亡率获益。
