School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Atherosclerosis. 2017 Dec;267:158-166. doi: 10.1016/j.atherosclerosis.2017.09.018. Epub 2017 Sep 27.
Statin is not beneficial for dialysis patients but moderate to high intensity statin is beneficial for patients after acute myocardial infarction (MI). The aim of this study was to evaluate the effect of moderate to high intensity statin on mortality, cardiovascular outcomes in dialysis patients after acute MI.
Data on dialysis patients were retrieved from the National Health Insurance Research Database in Taiwan. Dialysis patients admitted for MI were selected and divided into two groups according to statin prescription or not after MI. All-cause mortality and cardiovascular outcomes after a 4-year follow-up were analyzed after propensity score matching (PSM).
We identified 790 patients who received moderate to high intensity statin therapy and 1788 patients who did not receive any statins after acute MI and clinical outcomes were analyzed after 1:1 PSM. The benefit of statin on mortality therapy appeared from 1 year to the end of the 4-year follow-up period after hospitalization (statin group versus non-statin group: 22.9% vs. 31.1% at 1 year (HR: 0.70; 95% CI: 0.58-0.85); 48.0% vs. 55.1% at the end of the 4 years (HR: 0.76; 95% CI: 0.67-0.88)). In addition, the impact of statin therapy was stronger in patients with shock at admission (p = 0.035). There were no differences in any individual cardiovascular outcome or adverse event.
Moderate to high intensity statin therapy might lower all-cause mortality in dialysis patients after acute MI, especially those with shock, but not influence cardiovascular outcomes and any adverse events.
他汀类药物对透析患者无益，但中高强度他汀类药物对急性心肌梗死（MI）后的患者有益。本研究旨在评估中高强度他汀类药物对急性 MI 后透析患者死亡率和心血管结局的影响。
从中国台湾全民健康保险研究数据库中检索透析患者数据。选择因 MI 住院的透析患者，并根据 MI 后是否开具他汀类药物将其分为两组。在倾向评分匹配（PSM）后分析 4 年随访期间的全因死亡率和心血管结局。
我们确定了 790 名接受中高强度他汀类药物治疗的患者和 1788 名急性 MI 后未接受任何他汀类药物治疗的患者，并在 1:1 PSM 后分析了临床结局。他汀类药物对死亡率的治疗效果在住院后 1 年至 4 年随访期末显现（他汀类药物组与非他汀类药物组：1 年时分别为 22.9%和 31.1%（HR：0.70；95%CI：0.58-0.85）；4 年期末时分别为 48.0%和 55.1%（HR：0.76；95%CI：0.67-0.88））。此外，入院时休克患者的他汀类药物治疗效果更强（p=0.035）。在任何单个心血管结局或不良事件方面，两组均无差异。
中高强度他汀类药物治疗可能降低急性 MI 后透析患者的全因死亡率，尤其是休克患者，但不会影响心血管结局和任何不良事件。
