Kenaan Mohamad, Seth Milan, Aronow Herbert D, Naoum Joseph, Wunderly Douglas, Mitchiner James, Moscucci Mauro, Gurm Hitinder S
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI.
Michigan Heart and Vascular Institute, St Joseph Mercy Hospital, Ann Arbor, MI.
Am Heart J. 2014 Jul;168(1):110-6.e3. doi: 10.1016/j.ahj.2014.03.016. Epub 2014 Apr 5.
Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is.
We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data.
Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P = .98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P = .11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P = .96).
A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.
早期研究表明，在经皮冠状动脉介入治疗（PCI）前使用他汀类药物与围手术期心肌梗死和造影剂肾病风险降低相关。美国心脏病学会/美国心脏协会现行指南推荐在PCI前常规使用他汀类药物。目前尚不清楚在临床实践中该推荐的遵循情况以及其对预后的影响。
我们评估了2010年1月至2012年12月期间在密歇根州44家医院接受PCI并纳入密歇根蓝十字蓝盾心血管联盟PCI注册研究的患者中，他汀类药物预处理的发生率及住院期间的预后。采用倾向评分和精确匹配来调整PCI前他汀类药物的非随机使用情况。对与医疗保险数据相关联的部分患者评估长期死亡率。
我们的研究人群包括80493例患者，其中26547例（33%）在接受PCI前未接受他汀类药物治疗。与接受他汀类药物治疗的患者相比，未接受治疗的患者既往心血管疾病发生率较低。在匹配分析中，PCI前未使用他汀类药物与住院死亡率（0.43%对0.42%，比值比1.00，95%可信区间0.70 - 1.42，P = 0.98）和围手术期心肌梗死发生率（2.34%对2.10%，比值比1.13，95%可信区间0.97 - 1.32，P = 0.11）与接受他汀类药物治疗者相似。同样，在冠状动脉搭桥术、脑血管意外（CVA）或造影剂肾病发生率方面未观察到差异。在纳入的医疗保险患者亚组中，PCI前使用他汀类药物与长期生存率之间无关联（风险比 = 1.0，P = 0.96）。
相当数量的患者在未进行他汀类药物预处理的情况下接受PCI，但这与住院期间的主要并发症或长期死亡率无关。
