Anghel Larisa, Tudurachi Bogdan-Sorin, Tudurachi Andreea, Benchea Laura-Cătălina, Clement Alexandra, Zanfirescu Răzvan-Liviu, Sascău Radu Andy, Stătescu Cristian
Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania.
Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania.
J Pers Med. 2024 Jul 19;14(7):771. doi: 10.3390/jpm14070771.
: Coronary artery disease, a leading global cause of death, highlights the essential need for early detection and management of modifiable cardiovascular risk factors to prevent further coronary events. : This study, conducted at a major tertiary academic PCI-capable hospital in Romania from 1 January 2011 to 31 December 2013, prospectively analyzed 387 myocardial infarction with ST-segment elevation (STEMI) patients to assess the long-term management of modifiable risk factors. This study particularly focused on patients with new-onset left bundle branch block (LBBB) and compared them with a matched control group without LBBB. : During median follow-up periods of 9.6 years for LBBB patients and 9.2 years for those without LBBB, it was found that smoking, obesity, and dyslipidemia were prevalent in 73.80%, 71.42%, and 71.42% of the LBBB group, respectively, at baseline. Significant reductions in smoking were observed in both groups, with the LBBB group's smoking rates decreasing significantly to 61.90% ( = 0.034). Patients with LBBB more frequently achieved low-density lipoprotein cholesterol (LDLc) target levels during the follow-up period (from 71.42% to 59.52%; = 0.026) compared to the control group (from 66.67% to 71.42%; = 0.046). Prescription rates for dual antiplatelet therapy (DAPT), angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs), beta-blockers, and statins were initially high but then decreased by the follow-up. Statin use was reduced from 97.62% to 69.04% ( = 0.036) in the LBBB group and from 100% to 61.90% ( = 0.028) in the non-LBBB group. This study also highlighted moderate correlations between obesity ( = 0.627, = 0.040) and subsequent coronary reperfusion in the LBBB group, while dyslipidemia and smoking showed very strong positive correlations across both groups (dyslipidemia: = 0.903, = 0.019 for LBBB; = 0.503, = 0.048 for non-LBBB; smoking: = 0.888, = 0.035 for LBBB; = 0.517, = 0.010 for non-LBBB). : These findings underscore the crucial need for targeted management of modifiable risk factors, particularly focusing on dyslipidemia and smoking cessation, to improve subsequent coronary reperfusion outcomes post-STEMI, especially in patients with complicating factors like LBBB.
冠状动脉疾病是全球主要的死亡原因，凸显了早期发现和管理可改变的心血管危险因素以预防进一步冠状动脉事件的迫切需求。
本研究于2011年1月1日至2013年12月31日在罗马尼亚一家具备主要三级学术PCI能力的医院进行，前瞻性分析了387例ST段抬高型心肌梗死（STEMI）患者，以评估可改变危险因素的长期管理情况。本研究特别关注新发左束支传导阻滞（LBBB）患者，并将他们与无LBBB的匹配对照组进行比较。
在LBBB患者的中位随访期为9.6年，无LBBB患者为9.2年期间，发现基线时LBBB组中吸烟、肥胖和血脂异常的发生率分别为73.80%、71.42%和71.42%。两组吸烟率均显著降低，LBBB组吸烟率显著降至61.90%（P = 0.034）。与对照组（从66.67%降至71.42%；P = 0.046）相比，LBBB组患者在随访期间更频繁地达到低密度脂蛋白胆固醇（LDLc）目标水平（从71.42%降至59.52%；P = 0.026）。双联抗血小板治疗（DAPT）、血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARBs）、β受体阻滞剂和他汀类药物的处方率最初较高，但随后在随访时下降。LBBB组他汀类药物的使用从97.62%降至69.04%（P = 0.036），非LBBB组从100%降至61.90%（P = 0.028）。本研究还强调了LBBB组中肥胖（r = 0.627，P = 0.040）与随后冠状动脉再灌注之间的中度相关性，而血脂异常和吸烟在两组中均显示出非常强的正相关性（血脂异常：LBBB组r = 0.903，P = 0.019；非LBBB组r = 0.503，P = 0.048；吸烟：LBBB组r = 0.888，P = 0.035；非LBBB组r = 0.517，P = 0.010）。
这些发现强调了针对性管理可改变危险因素的迫切需求，尤其关注血脂异常和戒烟，以改善STEMI后随后的冠状动脉再灌注结果，特别是在有LBBB等复杂因素的患者中。
