Kim Min Chul, Cho Jae Yeong, Jeong Hae Chang, Lee Ki Hong, Park Keun Ho, Sim Doo Sun, Yoon Nam Sik, Yoon Hyun Joo, Kim Kye Hun, Hong Young Joon, Park Hyung Wook, Kim Ju Han, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun, Seung Ki-Bae, Chang Kiyuk, Ahn Youngkeun
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
Department of Cardiology, Cardiovascular Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Am J Cardiol. 2015 Jan 1;115(1):1-7. doi: 10.1016/j.amjcard.2014.09.039. Epub 2014 Oct 12.
Many patients discontinue statin after acute myocardial infarction (AMI) despite its necessity. However, limited data are available describing the clinical impact of statin withdrawal after AMI. This study enrolled 3,807 patients in the Korean multicenter registry who survived for 1 year after AMI. All patients were prescribed statin at discharge and were divided into 2 groups on the basis of statin withdrawal history; 603 patients had a history of statin discontinuation and 3,204 patients continued statin therapy. The primary outcome was mortality from any cause. We also analyzed the incidence of cardiac death, nonfatal myocardial infarction, any revascularization, and stroke. The duration of follow-up was 4 years after AMI. Statin withdrawal was associated with higher mortality than continued statin treatment (hazard ratio 3.45, 95% confidence interval 2.81 to 4.24, p <0.001), primarily as the result of increased cardiac mortality (hazard ratio 4.65, 95% confidence interval 3.14 to 6.87, p <0.001). However, the incidences of nonfatal myocardial infarction, any revascularization, and stroke were not different between the groups. Analysis by propensity score matching did not affect the results. In conclusion, many patients experienced statin withdrawal after AMI, which significantly increased long-term mortality in the present study. Careful education and monitoring are needed to reduce adverse cardiac outcomes in patients after AMI.
许多患者在急性心肌梗死（AMI）后尽管需要他汀类药物治疗，但仍会停药。然而，关于AMI后停用他汀类药物的临床影响的数据有限。本研究纳入了韩国多中心登记处3807例AMI后存活1年的患者。所有患者出院时均被处方使用他汀类药物，并根据他汀类药物停药史分为两组；603例患者有他汀类药物停药史，3204例患者继续接受他汀类药物治疗。主要结局是任何原因导致的死亡。我们还分析了心源性死亡、非致命性心肌梗死、任何血管重建和中风的发生率。随访时间为AMI后4年。与继续使用他汀类药物治疗相比，停用他汀类药物与更高的死亡率相关（风险比3.45，95%置信区间2.81至4.24，p<0.001），主要是由于心源性死亡率增加（风险比4.65，95%置信区间3.14至6.87，p<0.001）。然而，两组之间非致命性心肌梗死、任何血管重建和中风的发生率没有差异。倾向评分匹配分析不影响结果。总之，许多患者在AMI后停用他汀类药物，在本研究中这显著增加了长期死亡率。需要进行仔细的教育和监测，以减少AMI后患者的不良心脏结局。
