急性冠状动脉综合征后未使用高效他汀类药物的预测因素：来自达普拉替布稳定斑块-心肌梗死溶栓52（SOLID-TIMI 52）试验的见解
Predictors of Nonuse of a High-Potency Statin After an Acute Coronary Syndrome: Insights From the Stabilization of Plaques Using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) Trial.
作者信息
Eisen Alon, Cannon Christopher P, Braunwald Eugene, Steen Dylan L, Zhou Jing, Goodrich Erica L, Im KyungAh, Dalby Anthony J, Spinar Jindrich, Daga Shruti, Lukas Mary Ann, O'Donoghue Michelle L
机构信息
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
University of Cincinnati, OH.
出版信息
J Am Heart Assoc. 2017 Jan 11;6(1):e004332. doi: 10.1161/JAHA.116.004332.
BACKGROUND
High-potency statins reduce cardiovascular events after acute coronary syndromes but remain underused in clinical practice. We examined predictors of nonuse of high-potency statins after acute coronary syndromes.
METHODS AND RESULTS
The Stabilization of pLaques usIng Darapladib-Thrombolysis in Myocardial Infarction (SOLID-TIMI 52) trial enrolled patients after an acute coronary syndrome in 36 countries between 2009 and 2011. Statin use was strongly encouraged throughout the trial, and statin potency was at the discretion of the treating physician. A high-potency statin was defined as ≥40 mg atorvastatin, ≥20 mg rosuvastatin, or 80 mg simvastatin daily. Predictors of nonuse of high-potency statins were examined using logistic regression. Of the patients included (n=12 446), 11 850 (95.2%) were treated with a statin at baseline after acute coronary syndrome (median 14 days), but only 5212 (41.9%) were on a high-potency statin. Selected patient factors associated with nonuse of high-potency statins included age ≥75 years (odds ratio 1.39, 95% CI 1.24-1.56), female sex (odds ratio 1.11, 95% CI 1.02-1.22), renal dysfunction (odds ratio 1.17, 95% CI 1.03-1.32), and heart failure during hospital admission (odds ratio 1.43, 95% CI 1.27-1.62). At 3 months after baseline, only 49% of patients had low-density lipoprotein cholesterol <70 mg/dL. Among the 5490 patients (59%) who were not on a high-potency statin at 3 months, lower low-density lipoprotein cholesterol was a predictor of nonuse of a high-potency statin after a median of 2.3 years (odds ratio 1.15 for 10 mg/dL decrease, 95% CI 1.11-1.19).
CONCLUSION
Despite the widespread use of statins after acute coronary syndromes, most patients are not treated with high-potency statins early and late after the event, including patients at the highest risk of recurrent cardiovascular events.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01000727.
背景
强效他汀类药物可降低急性冠状动脉综合征后的心血管事件发生率，但在临床实践中仍未得到充分使用。我们研究了急性冠状动脉综合征后未使用强效他汀类药物的预测因素。
方法与结果
使用达普拉布-心肌梗死溶栓治疗（SOLID-TIMI 52）试验在2009年至2011年期间纳入了36个国家的急性冠状动脉综合征患者。在整个试验过程中大力鼓励使用他汀类药物，他汀类药物的剂量由治疗医生决定。强效他汀类药物定义为每日阿托伐他汀≥40毫克、瑞舒伐他汀≥20毫克或辛伐他汀80毫克。使用逻辑回归分析未使用强效他汀类药物的预测因素。在纳入的患者（n = 12446）中，11850例（95.2%）在急性冠状动脉综合征后基线时（中位数为14天）接受了他汀类药物治疗，但只有5212例（41.9%）使用了强效他汀类药物。与未使用强效他汀类药物相关的选定患者因素包括年龄≥75岁（比值比1.39，95%可信区间1.24 - 1.56）、女性（比值比1.11，95%可信区间1.02 - 1.22）、肾功能不全（比值比1.17，95%可信区间1.03 - 1.32）以及住院期间心力衰竭（比值比1.43，95%可信区间1.27 - 1.62）。在基线后3个月时，只有49%的患者低密度脂蛋白胆固醇<70毫克/分升。在3个月时未使用强效他汀类药物的5490例患者（59%）中，较低的低密度脂蛋白胆固醇是2.3年中位数后未使用强效他汀类药物的预测因素（每降低10毫克/分升的比值比为1.15，95%可信区间1.11 - 1.19）。
结论
尽管急性冠状动脉综合征后他汀类药物广泛使用，但大多数患者在事件发生的早期和晚期均未接受强效他汀类药物治疗，包括心血管事件复发风险最高的患者。
临床试验注册
Zotero 插件