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韩国人群中新一代药物洗脱支架时代经皮冠状动脉介入治疗后伴有或不伴有血脂异常的急性心肌梗死患者他汀类药物治疗的两年结局:来自韩国急性心肌梗死注册研究的数据

Two-year outcomes of statin therapy in patients with acute myocardial infarction with or without dyslipidemia after percutaneous coronary intervention in the era of new-generation drug-eluting stents within Korean population: Data from the Korea Acute Myocardial Infarction Registry.

作者信息

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

机构信息

Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.

Chonnam National University Hospital, Gwangju, South Korea.

出版信息

Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1264-1275. doi: 10.1002/ccd.27985. Epub 2018 Nov 25.

DOI:10.1002/ccd.27985
PMID:30474346
Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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。

结论

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。

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