Kim Min Chul, Ahn Youngkeun, Cho Jae Yeong, Lee Ki Hong, Sim Doo Sun, Yoon Nam Sik, Yoon Hyun Ju, Kim Kye Hun, Hong Young Joon, Park Hyung Wook, Kim Ju Han, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun, Chang Kiyuk, Seung Ki Bae
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean Circ J. 2019 May;49(5):419-433. doi: 10.4070/kcj.2018.0341. Epub 2019 Feb 12.
Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation.
A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24-48 hours) and group 3 (≥48 hours). We also made 3 stratified models to reduce bias: model 1 (<24 hours vs. ≥24 hours), model 2 (<48 hours vs. ≥48 hours) and model 3 (<24 hours vs. 24-48 hours). The endpoint was major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction and target-vessel revascularization) during median 3.8 years.
During follow-up, incidence of MACE was lower in early statin group in both model 1 (14.3% vs. 18.4%, hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91; p=0.002) and model 2 (14.6% vs. 19.7%, HR, 0.81; 95% CI, 0.67-0.97; p=0.022). After propensity-score matching, results remained unaltered. Statin initiation <24 hours reduced MACE compared to statin initiation ≥24 hours in model 1. Statin initiation <48 hours also reduced MACE compared to statin initiation later in model 2. However, there was no difference in incidence of MACE between statin initiation <24 hours and 24-48 hours) in model 3.
Early statin therapy within 48 hours after admission in statin-naïve patients with AMI reduced long-term clinical outcomes compared with statin initiation later.
ClinicalTrials.gov Identifier: NCT02385682.
尽管当前指南推荐急性心肌梗死（AMI）患者早期启动他汀治疗，但对于他汀启动的最佳时机尚无共识。
共分析了3921例接受经皮冠状动脉介入治疗且未服用过他汀的患者，并根据他汀启动时间分为3组：第1组（入院后<24小时启动他汀）、第2组（24 - 48小时）和第3组（≥48小时）。我们还构建了3个分层模型以减少偏倚：模型1（<24小时与≥24小时）、模型2（<48小时与≥48小时）和模型3（<24小时与24 - 48小时）。终点为中位3.8年期间的主要不良心脏事件（MACE；包括心源性死亡、心肌梗死和靶血管血运重建的复合事件）。
随访期间，在模型1（14.3%对18.4%，风险比[HR]，0.77；95%置信区间[CI]，0.66 - 0.91；p = 0.002）和模型2（14.6%对19.7%，HR，0.81；95% CI，0.67 - 0.97；p = 0.022）中，早期他汀治疗组的MACE发生率均较低。倾向评分匹配后，结果未改变。在模型1中，与≥24小时启动他汀相比，<24小时启动他汀可降低MACE。在模型2中，与更晚启动他汀相比，<48小时启动他汀也可降低MACE。然而，在模型3中，<24小时启动他汀与24 - 48小时启动他汀的MACE发生率无差异。
与较晚启动他汀相比，AMI未服用过他汀的患者在入院后48小时内早期进行他汀治疗可改善长期临床结局。
ClinicalTrials.gov标识符：NCT02385682。
