Ogiso Masataka, Yamaguchi Junichi, Kawada-Watanabe Erisa, Koyanagi Ryo, Sekiguchi Haruki, Sakamoto Tomohiro, Iguchi Nobuo, Tanaka Hiroyuki, Okada Hisayuki, Ota Yoshimi, Jujo Kentaro, Fujii Shinya, Ogawa Hiroshi, Hagiwara Nobuhisa
Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University Tokyo Japan.
Division of Cardiology, Cardiovascular Center, Saisei-Kai Kumamoto Hospital Kumamoto Japan.
Circ Rep. 2020 Jan 28;2(2):128-134. doi: 10.1253/circrep.CR-19-0118.
The effects of aggressive lipid-lowering therapy according to the number of diseased coronary arteries in acute coronary syndrome (ACS) are still controversial. This study investigated the efficacy of this therapy in ACS patients with multivessel disease (MVD) and single-vessel disease (SVD). The subjects were derived from the HIJ-PROPER study, in which ACS patients with dyslipidemia were randomized to receive either pitavastatin+ezetimibe (targeting low-density lipoprotein cholesterol [LDL-C] <70 mg/dL) or pitavastatin monotherapy (targeting LDL-C <90 mg/dL). In this study, treatment efficacy was compared between patients with MVD and SVD. The primary endpoint was a composite of major advanced cardiovascular events (MACE; all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization). We identified 1,702 eligible patients (MVD, n=869; SVD, n=833; mean age, 65.6 years; male, 75.6%; acute revascularization, 96.2%). MACE incidence was significantly higher in the MVD group than in the SVD group (43.7% vs. 25.9%, HR, 1.95; 95% CI: 1.65-2.31, P<0.001). In the SVD group, pitavastatin+ezetimibe had significantly fewer MACE than pitavastatin monotherapy (34.6% vs. 47.4%, HR, 0.72; 95% CI: 0.55-0.94, P=0.02). The benefits of aggressive lipid-lowering therapy, with the addition of ezetimibe to statins, were enhanced in ACS patients with SVD, but not with MVD, in the early invasive strategy era.
在急性冠状动脉综合征（ACS）中，根据病变冠状动脉数量进行强化降脂治疗的效果仍存在争议。本研究调查了这种治疗方法在多支血管病变（MVD）和单支血管病变（SVD）的ACS患者中的疗效。研究对象来自HIJ-PROPER研究，该研究将血脂异常的ACS患者随机分为两组，分别接受匹伐他汀+依折麦布治疗（目标低密度脂蛋白胆固醇[LDL-C]<70mg/dL）或匹伐他汀单药治疗（目标LDL-C<90mg/dL）。在本研究中，比较了MVD和SVD患者的治疗效果。主要终点是主要的晚期心血管事件（MACE；全因死亡、非致命性心肌梗死、非致命性卒中以及缺血驱动的血运重建）的复合终点。我们确定了1702例符合条件的患者（MVD，n = 869；SVD，n = 833；平均年龄65.6岁；男性占75.6%；急性血运重建率为96.2%）。MVD组的MACE发生率显著高于SVD组（43.7%对25.9%，HR为1.95；95%CI：1.65 - 2.31，P<0.001）。在SVD组中，匹伐他汀+依折麦布的MACE明显少于匹伐他汀单药治疗（34.6%对47.4%，HR为0.72；95%CI：0.55 - 0.94，P = 0.02）。在早期侵入性策略时代，对于SVD的ACS患者，他汀类药物联合依折麦布进行强化降脂治疗的益处得到增强，但MVD患者并非如此。
