不同类型他汀类药物对因缺血性心力衰竭住院患者临床结局的影响

Impact of Different Types of Statins on Clinical Outcomes in Patients Hospitalized for Ischemic Heart Failure.

作者信息

Zvizdić Faris, Godinjak Amina, Durak-Nalbantic Azra, Rama Admir, Iglica Amer, Vucijak-Grgurevic Marina, Sokolovic Sekib

机构信息

Department for Cardiology, Clinic for Heart, Vascular Diseases and Rheumatology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

Department for Emergency Medicine, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

出版信息

Med Arch. 2018 Dec;72(6):401-405. doi: 10.5455/medarh.2018.72.401-405.

DOI:10.5455/medarh.2018.72.401-405

PMID:30814769

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6340614/

Abstract

INTRODUCTION

The effect of statins on risk of heart failure (HF) hospitalization and lethal outcome remains dubious.

AIM

To investigate whether statin therapy improves clinical outcomes in patients hospitalized for ischemic heart failure (HF), to compare the efficacy of lipophilic and hydrophilic statins and to investigate which statin subtype provides better survival and other outcome benefits.

MATERIAL AND METHODS

Total amount of 155 patients in the study were admitted to the Clinic for Cardiology, Rheumatology and Vascular diseases in Clinical Center University of Sarajevo in the period from January 2014- December 2017. Inclusion criteria was HF caused by ischemic coronary artery disease upon admission. For each patient the following data were obtained: gender, age, comorbidities and medications on discharge. New York Heart Association (NYHA) class for heart failure was determined by physician evaluation and left ventricle ejection fraction (LVEF) was determined by echocardiography. The patients were followed for a period of two years. Outcome points were: rehospitalization, in-hospital death, mortality after 6 months, 1 year and 2 years. All-cause mortality included cardiovascular events or worsening heart failure.

RESULTS

Overall, 58.9% of HF patients received statin therapy, with 33.9% patients receiving atorvastatin and 25.0% rosuvastatin therapy. The most frequent rehospitalization was in patients without statin therapy (66.7%), followed by patients on rosuvastatin (64.1%), and atorvastatin (13.2%), with statistically significant difference p = 0.001 between the groups. Mortality after 6 months, 1 year and 2 years was the most frequent in patients without statin therapy with a statistically significant difference (p = 0.001). Progression of HF accounted for 31.7% of mortality in patients without statin therapy, 12.8% in patients on rosuvastatin therapy and 3.8% in patients on atorvastatin therapy (p = 0.004).

CONCLUSION

Lipophilic statin therapy is associated with substantially better long-term outcomes in patients with HF.

摘要

引言

他汀类药物对心力衰竭（HF）住院风险和致死结局的影响仍不明确。

目的

研究他汀类药物治疗是否能改善因缺血性心力衰竭（HF）住院患者的临床结局，比较亲脂性他汀和亲水性他汀的疗效，并探究哪种他汀亚型能提供更好的生存及其他结局益处。

材料与方法

2014年1月至2017年12月期间，共有155例患者被纳入萨拉热窝大学临床中心心脏病学、风湿病学和血管疾病诊所的研究。纳入标准为入院时因缺血性冠状动脉疾病导致的HF。为每位患者获取以下数据：性别、年龄、合并症及出院时的用药情况。心力衰竭的纽约心脏协会（NYHA）分级由医生评估确定，左心室射血分数（LVEF）通过超声心动图测定。对患者进行为期两年的随访。结局指标包括：再次住院、院内死亡、6个月、1年和2年后的死亡率。全因死亡率包括心血管事件或心力衰竭恶化。

结果

总体而言，58.9%的HF患者接受了他汀类药物治疗，其中33.9%的患者接受阿托伐他汀治疗，25.0%的患者接受瑞舒伐他汀治疗。再次住院率最高的是未接受他汀类药物治疗的患者（66.7%），其次是接受瑞舒伐他汀治疗的患者（64.1%）和阿托伐他汀治疗的患者（13.2%），组间差异有统计学意义（p = 0.001）。6个月、1年和2年后的死亡率在未接受他汀类药物治疗的患者中最高，差异有统计学意义（p = 0.001）。HF进展在未接受他汀类药物治疗的患者死亡率中占31.7%，在接受瑞舒伐他汀治疗的患者中占12.8%，在接受阿托伐他汀治疗的患者中占3.8%（p = 0.004）。