Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China.
BMJ Open. 2022 Sep 14;12(9):e056236. doi: 10.1136/bmjopen-2021-056236.
To determine the associated factors for discontinuation of statin use 1 year after discharge in patients who survived from acute coronary syndrome (ACS) in China.
75 hospitals across China.
A cohort follow-up study.
The study included 10 337 patients with ACS hospitalised in 2007-2010 and discharged with statins from 75 hospitals in China in the Clinical Pathways for Acute Coronary Syndromes in China Study-Phase 2 (CPACS-2), who were followed-up at 6 and 12 months postdischarge.
The primary outcome was the discontinuation of statin use defined as not in current use of statin at either 6-month or 12-month follow-up.
Multivariable logistic regression model showed that patients who did not have cholesterol measurement (adjusted OR=1.29; 95% CI: 1.10 to 1.50) and patients with either higher (1.27; 1.13 to 1.43) or lower dose of statin (1.22; 1.07 to 1.40), compared with those with standard dose, were more likely to discontinue the use of statin. In addition, patients on the CPACS-2 intervention pathway (adjusted OR=0.83; 95% CI: 0.74 to 0.94), patients with medical insurance (0.75; 0.67 to 0.85), history of hypertension (0.83; 0.75 to 0.92), high low-density lipoprotein cholesterol (0.70; 0.57 to 0.87) at the baseline, prior statin use (0.73; 0.63 to 0.84), use of atorvastatin (0.78; 0.70 to 0.88) and those who underwent percutaneous coronary intervention or coronary artery bypass grafting during hospitalisation (0.47; 0.43 to 0.53) were less likely to discontinue statin use. The 1-year statin discontinuation rate decreased from 29.5% in 2007-2008 to 17.8% in 2010 (adjusted OR=0.60; 95% CI: 0.51 to 0.70).
Implementing clinical pathway, enhancing medical insurance coverage, strengthening health education in both physicians and patients, using statin at standard dosage may help improve the adherence to statin use after discharge in Chinese patients with ACS.
Australian New Zealand Clinical Trials Registry (ACTRN12609000491268).
在中国急性冠状动脉综合征（ACS）患者出院后 1 年内，确定他汀类药物停药的相关因素。
中国 75 家医院。
队列随访研究。
该研究纳入了 2007-2010 年在中国 75 家医院因 ACS 住院并出院时开具他汀类药物的 10337 例患者，在中国急性冠状动脉综合征临床路径研究-第 2 阶段（CPACS-2）中，这些患者在出院后 6 个月和 12 个月进行了随访。
主要结局是他汀类药物停药的定义为在 6 个月或 12 个月随访时未使用他汀类药物。
多变量逻辑回归模型显示，未进行胆固醇检测的患者（调整后的比值比[OR] = 1.29；95%置信区间[CI]：1.10 至 1.43）和他汀类药物剂量较高（1.27；1.13 至 1.43）或较低（1.22；1.07 至 1.40）的患者，与使用标准剂量的患者相比，更有可能停止使用他汀类药物。此外，CPACS-2 干预路径的患者（调整后的 OR = 0.83；95%CI：0.74 至 0.94）、有医疗保险的患者（0.75；0.67 至 0.85）、基线时患有高血压（0.83；0.75 至 0.92）、低密度脂蛋白胆固醇升高（0.70；0.57 至 0.87）、之前使用过他汀类药物（0.73；0.63 至 0.84）、使用阿托伐他汀（0.78；0.70 至 0.88）以及在住院期间接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的患者（0.47；0.43 至 0.53），不太可能停止使用他汀类药物。他汀类药物停药率从 2007-2008 年的 29.5%下降到 2010 年的 17.8%（调整后的 OR = 0.60；95%CI：0.51 至 0.70）。
实施临床路径、扩大医疗保险覆盖范围、加强医患健康教育、使用标准剂量的他汀类药物可能有助于提高中国 ACS 患者出院后他汀类药物的依从性。
澳大利亚新西兰临床试验注册中心（ACTRN12609000491268）。
