Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
Am Heart J. 2019 Jun;212:120-128. doi: 10.1016/j.ahj.2019.02.019. Epub 2019 Mar 13.
Lowering low-density lipoprotein cholesterol (LDL-C) by statins is a key strategy for secondary prevention of acute coronary syndrome (ACS). However, few studies have examined prehospital statin use and admission LDL-C levels in ACS patients with history of myocardial infarction (MI) or revascularization. This study aimed to assess use of prehospital statins and LDL-C levels at admission in ACS patients with history of MI or revascularization.
Improving Care for Cardiovascular Disease in China project was a nationwide registry, with 192 participating hospitals reporting details of clinical information of ACS patients from November 2014. By May 2018, 80,282 patients with ACS were included. LDL-C levels were obtained from the initial admission lipid testing.
Of the 80,282 ACS patients, 6,523 with a history of MI or revascularization were enrolled. Among them, 50.8% were receiving lipid-lowering therapy before hospitalization (statin monotherapy in 98.4%, combination in 1.2%). A total of 30.1% of patients had LDL-C < 70 mg/dL at admission. In patients receiving prehospital statins, 36.1% had LDL-C < 70 mg/dL compared to 24.0% without prehospital statins (P < .001). At discharge, 91.8% of patients were treated with statin monotherapy, 90.7% at moderate doses irrespective of prehospital statin use and LDL-C levels at admission.
Among ACS patients with history of MI or revascularization, half were not being treated with statin therapy prior to admission, and most had not attained LDL-C < 70 mg/dL despite prehospital statin use. There is an important opportunity to provide intensive statin or combination lipid-lowering therapy to these very high risk patients.
通过他汀类药物降低低密度脂蛋白胆固醇（LDL-C）是急性冠状动脉综合征（ACS）二级预防的关键策略。然而，很少有研究检查过有心肌梗死（MI）或血运重建史的 ACS 患者的院前他汀类药物使用情况和入院时 LDL-C 水平。本研究旨在评估有 MI 或血运重建史的 ACS 患者的院前他汀类药物使用情况和入院时 LDL-C 水平。
改善中国心血管疾病护理项目是一项全国性登记研究，有 192 家参与医院报告了 2014 年 11 月至 2018 年 5 月期间 ACS 患者的临床信息详情。共纳入 80282 例 ACS 患者。LDL-C 水平从初始入院血脂检测中获得。
在 80282 例 ACS 患者中，有 6523 例有 MI 或血运重建史。其中，50.8%在入院前接受降脂治疗（他汀类药物单药治疗占 98.4%，联合治疗占 1.2%）。入院时，共有 30.1%的患者 LDL-C<70mg/dL。在接受院前他汀类药物治疗的患者中，36.1%的患者 LDL-C<70mg/dL，而未接受院前他汀类药物治疗的患者为 24.0%（P<0.001）。出院时，91.8%的患者接受他汀类药物单药治疗，无论是否使用院前他汀类药物以及入院时 LDL-C 水平如何，90.7%的患者接受中等剂量治疗。
在有 MI 或血运重建史的 ACS 患者中，有一半患者在入院前未接受他汀类药物治疗，尽管使用了院前他汀类药物，但大多数患者的 LDL-C 未达到<70mg/dL。为这些极高危患者提供强化他汀类药物或联合降脂治疗的机会非常重要。
