Kim Yong Hoon, Her Ae-Young, Jeong Myung Ho, Kim Byeong-Keuk, Shin Dong-Ho, Kim Jung-Sun, Ko Young-Guk, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
Chonnam National University Hospital, Gwangju, South Korea.
Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1264-1275. doi: 10.1002/ccd.27985. Epub 2018 Nov 25.
Limited studies focused on long-term outcomes of statin therapy in patients with acute myocardial infarction (AMI) with or without dyslipidemia after percutaneous coronary intervention (PCI) in the era of new-generation drug-eluting stents (DES). We thought to investigate 2-year clinical outcomes of statin therapy in these patients.
A total of 18,137 eligible AMI patients (from the Korea AMI Registry [KAMIR]) were finally enrolled and divided into four groups according to the presence or absence of dyslipidemia and statin therapy (dyslipidemia+/statin- [group A, 309 patients], dyslipidemia+/statin+ [group B, 2094 patients], dyslipidemia-/statin- [group C, 672 patients], dyslipidemia-/statin+ [group D, 15062 patients]). The primary outcome was major adverse cardiac event (MACE) defined as all-cause death, myocardial infarction (MI) and revascularization.
During the 2-year follow-up period, the cumulative incidence of MACE in the group A was higher than the group B (adjusted hazard ratio [HR], 2.207; 95% confidence interval (CI), 1.098-3.743; p = .024) and the group D (adjusted HR, 2.110; 95% CI, 1.240-3.593, p = .006). This significantly increased incidence of MACE caused by the higher cumulative incidences of all-cause death and cardiac death (CD) in the group A compared with groups B and D. However, the cumulative incidences of MI and revascularization were not significantly different among these four groups.
Statin therapy demonstrated significantly reduced incidences of MACE, all-cause death and CD compared with non-users after PCI in AMI patients with or without dyslipidemia during 2-year follow-up period in the era of new-generation DES.
在新一代药物洗脱支架(DES)时代,针对经皮冠状动脉介入治疗(PCI)后伴有或不伴有血脂异常的急性心肌梗死(AMI)患者进行他汀类药物治疗长期疗效的研究有限。我们旨在调查这些患者接受他汀类药物治疗的2年临床结局。
最终纳入了18137例符合条件的AMI患者(来自韩国急性心肌梗死注册研究[KAMIR]),并根据是否存在血脂异常和他汀类药物治疗情况分为四组(血脂异常+/他汀类药物- [A组,309例患者],血脂异常+/他汀类药物+ [B组,2094例患者],血脂异常-/他汀类药物- [C组,672例患者],血脂异常-/他汀类药物+ [D组,15062例患者])。主要结局是主要不良心脏事件(MACE),定义为全因死亡、心肌梗死(MI)和血运重建。
在2年随访期间,A组MACE的累积发生率高于B组(调整后风险比[HR],2.207;95%置信区间[CI],1.098 - 3.743;p = 0.024)和D组(调整后HR,2.110;95%CI,1.240 - 3.593,p = 0.006)。与B组和D组相比,A组全因死亡和心源性死亡(CD)的累积发生率较高,导致MACE发生率显著增加。然而,这四组之间MI和血运重建的累积发生率没有显著差异。
在新一代DES时代,在2年随访期间,与未使用他汀类药物的患者相比,他汀类药物治疗在伴有或不伴有血脂异常的AMI患者PCI后显著降低了MACE、全因死亡和CD的发生率。