Lee Vivian W, Chau Raymond Y, Cheung Herich Y, Yu Cheuk Man, Lam Yat Yin, Yan Bryan P
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, Hong Kong.
Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
BMC Cardiovasc Disord. 2015 Oct 7;15:117. doi: 10.1186/s12872-015-0117-y.
Utilization of lipid-lowering agents has been associated with improved long-term outcomes in acute coronary syndrome (ACS) patients. However, updated data regarding local use and outcomes was lacking.
We retrospectively reviewed 696 hospitalized patients in the local ACS registry of Prince of Wales Hospital during 1 January 2008 to 31 December 2009 with data retrieved using computerized clinical records of all patients.
Among the 402 MI patients included, 104 (25.9 %) were not prescribed with statins at discharge. Percutaneous coronary intervention (PCI) not performed or planned during hospitalization (OR: 0.324, p = 0.001) and latest lower LDL-C level before discharge (OR: 0.221 for an increment of 1 mmol/L, p = 0.009) were significant independent predictors of the absence of statin prescriptions at discharge. A significantly lower all-cause mortality rate (14.4 % vs 51.7 %, p < 0.001), fewer total hospitalizations (p < 0.001) and fewer hospitalizations due to cardiovascular problems (p < 0.001) were observed in patients discharged with statins. LDL-C goal attainment of < 2.6 mmol/L resulted in a significant reduction in mortality (10.8 % vs 24.2 %, p = 0.001), but not for goal attainment of < 1.8 mmol/L. Significant difference in survival existed only when LDL-C cut-off values were above 2.4 mmol/L.
This study revealed the under-utilization of statin therapy in eligible MI patients at discharge and unsatisfactory percentages of LDL-C goal attainment, and also reassured the role of low LDL-C reduction to < 2.6 mmol/L in the management of MI. However, the current study did not show that the lower LDL-C reduction improved survival of ACS patients. Further research should be conducted to assess the necessity of aggressive LDL-C reduction to < 1.8 mmol/L in local patients.
在急性冠状动脉综合征（ACS）患者中，使用降脂药物与改善长期预后相关。然而，缺乏关于当地使用情况和预后的最新数据。
我们回顾性分析了2008年1月1日至2009年12月31日期间威尔士亲王医院当地ACS登记处的696例住院患者，数据通过所有患者的计算机化临床记录获取。
在纳入的402例心肌梗死（MI）患者中，104例（25.9%）出院时未使用他汀类药物。住院期间未进行或未计划进行经皮冠状动脉介入治疗（PCI）（比值比：0.324，p = 0.001）以及出院前最新的较低低密度脂蛋白胆固醇（LDL-C）水平（每增加1 mmol/L的比值比：0.221，p = 0.009）是出院时未开具他汀类药物处方的显著独立预测因素。出院时使用他汀类药物的患者全因死亡率显著降低（14.4%对51.7%，p < 0.001），总住院次数减少（p < 0.001），因心血管问题住院次数减少（p < 0.001）。LDL-C目标达到<2.6 mmol/L导致死亡率显著降低（10.8%对24.2%，p = 0.001），但LDL-C目标达到<1.8 mmol/L时未出现显著降低。仅当LDL-C临界值高于2.4 mmol/L时，生存存在显著差异。
本研究揭示了符合条件的MI患者出院时他汀类药物治疗的使用不足以及LDL-C目标达成率不尽人意，同时也证实了将LDL-C降低至<2.6 mmol/L在MI管理中的作用。然而，当前研究未表明更低的LDL-C降低能改善ACS患者的生存。应进行进一步研究以评估在当地患者中将LDL-C积极降低至<1.8 mmol/L的必要性。
