Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
Eguchi Internal Medicine Clinic, 6-43 Enyaariharachou, Izumo, Shimane, 693-0023, Japan.
Heart Vessels. 2021 Mar;36(3):297-307. doi: 10.1007/s00380-020-01696-9. Epub 2020 Sep 3.
Little is known about the impact of a high-dose statin on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world Japanese patients. Between July 2011 and June 2017, 1110 consecutive STEMI patients underwent primary percutaneous coronary intervention at our hospital and were discharged. A high-dose statin was administered in 117 patients (10.5%) and non-high-dose statin was administered in 947 patients (85.3%). The low-density lipoprotein cholesterol level was significantly higher in the high-dose statin group at admission (129.8 ± 44.9 vs. 110.4 ± 32.7, p < 0.0001), but the levels were not significantly different at follow-up (86.7 ± 25.7 vs. 85.0 ± 25.0, p = 0.52). The cumulative 2-year incidence of a composite of cardiac death, myocardial infarction, ischemic stroke, and any unplanned coronary revascularization was significantly lower in the high-dose statin group (6.2% vs. 16.9%, log-rank p = 0.004). Propensity score matched analysis indicated similar results. Among the types of coronary revascularization, a high-dose statin was significantly correlated with a lower rate of de novo lesion revascularization (hazard ratio 0.31; 95% confidence interval 0.08-0.83; p = 0.02). The results of our analyses indicate that administration of a high-dose statin may result in better cardiovascular outcomes after STEMI mainly by reducing the rate of revascularization for de novo lesions regardless of the achieved low-density lipoprotein cholesterol level in real-world patients.
关于在真实世界中的日本患者中，高剂量他汀类药物对 ST 段抬高型急性心肌梗死（STEMI）后的心血管结局的影响知之甚少。在 2011 年 7 月至 2017 年 6 月期间，我院连续收治了 1110 例 STEMI 患者并进行了经皮冠状动脉介入治疗，患者出院后，117 例（10.5%）患者接受了高剂量他汀类药物治疗，947 例（85.3%）患者接受了非高剂量他汀类药物治疗。高剂量他汀类药物组入院时的低密度脂蛋白胆固醇水平明显更高（129.8±44.9 与 110.4±32.7，p<0.0001），但随访时无明显差异（86.7±25.7 与 85.0±25.0，p=0.52）。高剂量他汀类药物组的复合终点（心脏死亡、心肌梗死、缺血性卒中和任何计划性冠状动脉血运重建）2 年累积发生率明显较低（6.2%与 16.9%，对数秩检验 p=0.004）。倾向评分匹配分析表明了相似的结果。在冠状动脉血运重建的类型中，高剂量他汀类药物与新发病变血运重建率降低显著相关（风险比 0.31；95%置信区间 0.08-0.83；p=0.02）。我们的分析结果表明，在真实世界的患者中，无论实现的低密度脂蛋白胆固醇水平如何，给予高剂量他汀类药物治疗可能会通过降低新发病变的血运重建率来改善 STEMI 后的心血管结局。
