冠状动脉血运重建术后中等强度他汀类药物联合依折麦布与高强度他汀类药物的比较：一项队列研究

Moderate-Intensity Statins Plus Ezetimibe vs. High-Intensity Statins After Coronary Revascularization: A Cohort Study.

作者信息

Kim Juwon, Kang Danbee, Park Hyejeong, Kang Minwoong, Choi Ki Hong, Park Taek Kyu, Lee Joo Myung, Yang Jeong Hoon, Song Young Bin, Choi Jin-Ho, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Guallar Eliseo, Cho Juhee, Hahn Joo-Yong

机构信息

Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Cardiovasc Drugs Ther. 2023 Feb;37(1):141-150. doi: 10.1007/s10557-021-07256-1. Epub 2021 Sep 17.

DOI:10.1007/s10557-021-07256-1

PMID:34533691

Abstract

PURPOSE

Whether moderate-intensity statins plus ezetimibe could be an alternative to high-intensity statins in patients with atherosclerotic cardiovascular disease is unclear. We compared the risk of adverse cardiovascular events in patients receiving moderate-intensity statins plus ezetimibe vs. high-intensity statins after a coronary revascularization procedure using data from a large cohort study.

METHOD

Population-based cohort study using nationwide medical insurance data from Korea. Study participants (n = 20,070) underwent percutaneous coronary intervention or coronary artery bypass graft surgery between January 1, 2015, and December 31, 2016, and received moderate-intensity statins (atorvastatin 10-20 mg or rosuvastatin 5-10 mg) plus ezetimibe (n = 922) or high-intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg; n = 19,148). The primary outcome was a composite of cardiovascular mortality, hospitalization for myocardial infarction (MI), hospitalization for stroke, or revascularization.

RESULTS

At 12 months, the incidence rates of the primary outcome were 138.0 vs. 154.0 per 1000 person-years in the moderate-intensity stains plus ezetimibe and the high-intensity statins group, respectively. The fully adjusted hazard ratio [HR] for the primary outcome was 1.11 (95% confidence interval [CI] 0.86-1.42; p = 0.43). The multivariable-adjusted HR for a composite of cardiovascular mortality, hospitalization for MI, or hospitalization for stroke was 1.05 (95% CI 0.74-1.47; p = 0.80). During follow-up, the proportion of patients maintaining their initial lipid-lowering therapy was significantly higher in the moderate-intensity statins plus ezetimibe group than in the high-intensity statins group.

CONCLUSIONS

Patients undergoing a coronary revascularization procedure who received moderate-intensity statins plus ezetimibe showed similar rates of major adverse cardiovascular events as patients who received high-intensity statins.

摘要

目的

对于动脉粥样硬化性心血管疾病患者，中等强度他汀类药物联合依折麦布是否可替代高强度他汀类药物尚不清楚。我们利用一项大型队列研究的数据，比较了冠状动脉血运重建术后接受中等强度他汀类药物联合依折麦布与接受高强度他汀类药物的患者发生不良心血管事件的风险。

方法

基于韩国全国医疗保险数据进行的人群队列研究。研究参与者（n = 20,070）在2015年1月1日至2016年12月31日期间接受了经皮冠状动脉介入治疗或冠状动脉旁路移植术，并接受了中等强度他汀类药物（阿托伐他汀10 - 20毫克或瑞舒伐他汀5 - 10毫克）联合依折麦布（n = 922）或高强度他汀类药物（阿托伐他汀40 - 80毫克或瑞舒伐他汀20毫克；n = 19,148）。主要结局是心血管死亡、心肌梗死（MI）住院、中风住院或血运重建的复合结局。

结果

在12个月时，中等强度他汀类药物联合依折麦布组和高强度他汀类药物组的主要结局发生率分别为每1000人年138.0例和154.0例。主要结局的完全调整风险比[HR]为1.11（95%置信区间[CI] 0.86 - 1.42；p = 0.43）。心血管死亡、MI住院或中风住院复合结局的多变量调整HR为1.05（95% CI 0.74 - 1.47；p = 0.80）。在随访期间，中等强度他汀类药物联合依折麦布组维持初始降脂治疗的患者比例显著高于高强度他汀类药物组。