Güntekin Ünal, Tosun Veysel, Kilinç Ali Yaşar, Saydam Gündüzalp, Korucuk Necmettin, Bozdemir Mehmet Nuri
Department of Cardiology, Akdeniz University Faculty of Medicine, Antalya.
Department of Cardiology, Şanliurfa Education and Research Hospital, Şanliurfa.
Medicine (Baltimore). 2018 Sep;97(39):e12225. doi: 10.1097/MD.0000000000012225.
Statin nonadherence or discontinuation is associated with increased cardiovascular events. Many factors related to the physicians or the patients are influential in this. We aimed to compare the compliance with statin therapy between the patients who first presented with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UA) based on the target achievement according to the current dyslipidemia guidelines.We retrospectively acquired all the information about demographic characteristics, in-hospital revascularization procedures, prescribed treatments, and index and up to 6-month follow-up laboratory results of the first acute coronary syndrome patients. Acute coronary syndrome patients were divided into 3 groups as STEMI, NSTEMI, and UA.The STEMI group consisted of 260 patients, NSTEMI group consisted of 560 patients, and UA group consisted of 206 patients. Seventy-six percent of patients underwent percutaneous coronary interventions, 18.3% were managed medically, and 5.7% were referred for coronary artery bypass grafting. There was a significant decrease in low-density lipoprotein-cholesterol (LDL-C) values with the statin treatment at the follow-up in all 3 groups (for all P < .001). In the STEMI group, the percentage of those achieving the target LDL-C level was significantly higher than those who did not achieve the target according to both The American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology dyslipidemia guidelines. The LDL-C target achievement rates were also higher in the STEMI group than in the NSTEMI and UA groups.Our study concluded that statin treatment goals were more attained in STEMI patients than NSTEMI and UA. All physicians should encourage lifelong intensive statin treatment in UA and NSTEMI patients such as STEMI patients.
他汀类药物治疗的不依从或停药与心血管事件增加有关。许多与医生或患者相关的因素对此有影响。我们旨在根据当前血脂异常指南的目标达成情况，比较首次出现ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛（UA）患者在他汀类药物治疗方面的依从性。我们回顾性收集了所有首次急性冠状动脉综合征患者的人口统计学特征、院内血运重建程序、规定治疗以及首次就诊和长达6个月随访的实验室检查结果等信息。急性冠状动脉综合征患者分为STEMI、NSTEMI和UA三组。STEMI组有260例患者，NSTEMI组有560例患者，UA组有206例患者。76%的患者接受了经皮冠状动脉介入治疗，18.3%接受药物治疗，5.7%转诊接受冠状动脉旁路移植术。在所有三组中，随访时他汀类药物治疗使低密度脂蛋白胆固醇（LDL-C）值显著降低（所有P<0.001）。在STEMI组中，根据美国心脏病学会/美国心脏协会（ACC/AHA）和欧洲心脏病学会血脂异常指南，达到LDL-C目标水平的患者百分比显著高于未达到目标的患者。STEMI组的LDL-C目标达成率也高于NSTEMI组和UA组。我们的研究得出结论，与NSTEMI和UA患者相比，STEMI患者更能实现他汀类药物治疗目标。所有医生都应鼓励UA和NSTEMI患者像STEMI患者一样进行终身强化他汀类药物治疗。
