Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Postgrad Med J. 2021 May;97(1147):299-305. doi: 10.1136/postgradmedj-2019-137292. Epub 2021 Jan 15.
Use of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD.
We enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan's National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD.
Statin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), β receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001).
Among patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.
他汀类药物的使用与降低心血管疾病事件和死亡率风险相关。然而，在终末期肾病（ESRD）患者中，他汀类药物的保护作用存在争议。评估慢性他汀类药物使用对伴有 ESRD 的急性心肌梗死（AMI）患者临床结局的影响。
我们从台湾全民健康保险研究数据库中纳入了 8056 名初诊为 ESRD 并首次因 AMI 入院的患者。其中，2134 名患者接受了他汀类药物治疗。我们随机选择并使用年龄、性别、高血压、糖尿病（DM）、外周血管疾病（PVD）、心力衰竭（HF）、中风（CVA）、慢性阻塞性肺疾病与研究组相匹配的患者作为对照（非他汀类药物使用者）。我们比较了他汀类药物使用对伴有 ESRD 的 AMI 患者全因死亡率的影响。
与非他汀类药物使用者相比，伴有 ESRD 的 AMI 患者使用他汀类药物治疗后的生存率显著提高。在调整了合并症、男性患者和患有 DM、PVD、HF 和 CVA 的患者后，这些患者的长期生存率较低（均 p<0.001）。接受经皮冠状动脉介入治疗（p<0.001）、血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂（p<0.001）、β受体阻滞剂（p<0.001）和他汀类药物治疗（p=0.007）的患者具有更好的长期生存率。伴有 ESRD 的 AMI 患者接受他汀类药物治疗后，其死亡率显著低于非他汀类药物使用者（p<0.0001）。
在伴有 ESRD 的 AMI 患者中，他汀类药物治疗与降低全因死亡率相关。
