The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY; ACTION study group, Sorbonne université, INSERM UMRS 1166, Institut de Cardiologie (AP-HP), Hospital Pitié Salpêtrière, Paris, France.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Am Heart J. 2019 Jan;207:10-18. doi: 10.1016/j.ahj.2018.09.001. Epub 2018 Sep 12.
High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting.
All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg.
A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P < .001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non-ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P < .001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P < .001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P < .001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P < .001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P = .006), Asian races (OR 0.73, 95% CI 0.65-0.83, P < .001), and older age (OR 0.90, 95% CI 0.88-0.92, P < .001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P = .84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P = .05).
Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
高强度他汀类药物（HIS）被推荐用于经皮冠状动脉介入治疗（PCI）后的二级预防。我们旨在描述在常规护理环境下 PCI 后 HIS 处方的时间趋势和决定因素。
所有年龄≤75 岁、2011 年 1 月至 2016 年 5 月在城市三级护理中心接受 PCI 并出院且可用他汀类药物剂量数据的患者均被纳入研究。HIS 被定义为阿托伐他汀 40 或 80mg、瑞舒伐他汀 20 或 40mg 和辛伐他汀 80mg。
共纳入 10495 例连续患者。HIS 处方的患病率从 2011 年的 36.6%几乎翻了一番，达到 2016 年的 60.9%（P<.001），并且自 2013 年以来每年都呈稳步上升趋势。HIS 处方的预测因素包括 ST 段抬高型心肌梗死/非 ST 段抬高型心肌梗死（比值比 [OR] 4.60，95%置信区间 [CI] 3.98-5.32，P<.001）和不稳定型心绞痛（OR 1.31，95%CI 1.19-1.45，P<.001）作为首发事件、既往心肌梗死（OR 1.48，95%CI 1.34-1.65，P<.001）和同时处方β受体阻滞剂（OR 1.26，95%CI 1.12-1.43，P<.001）。相反，基线时他汀类药物治疗（OR 0.86，95%CI 0.77-0.96，P=0.006）、亚洲种族（OR 0.73，95%CI 0.65-0.83，P<.001）和年龄较大（OR 0.90，95%CI 0.88-0.92，P<.001）与 HIS 处方减少相关。HIS 处方与 1 年死亡率、心肌梗死或靶血管血运重建（调整后的危险比 0.98，95%CI 0.84-1.15，P=0.84）之间无显著相关性，尽管死亡率呈下降趋势（调整后的危险比 0.71，95%CI 0.50-1.00，P=0.05）。
尽管近年来 PCI 后 HIS 处方的比例有所增加，但仍存在重要的异质性，应加以解决，以改善 PCI 患者的治疗效果。
