Eccleston David, Chowdhury Enayet K, Wang Alex, Yeh Eric J, Rezkalla Nevine, Kathe Niranjan, Williamson Anna E, Schwarz Nisha
Advara HeartCare, Brisbane, Qld, Australia; University of Melbourne, Parkville, Vic, Australia.
Advara HeartCare, Brisbane, Qld, Australia.
Heart Lung Circ. 2025 Feb;34(2):173-181. doi: 10.1016/j.hlc.2024.08.003. Epub 2024 Dec 8.
Lipid-lowering therapy (LLT) is established as a key element in management of patients with coronary artery disease. However, the effect of time of initiation of LLT on outcomes is unclear.
The study compared outcomes of 5,433 patients from Advara HeartCare's Percutaneous Coronary Intervention (PCI) Registry on the basis of timing of LLT initiation classified as pre- or post-PCI admission. The prevalence of acute coronary syndrome (ACS) as the indication for PCI was compared in groups. In patients who underwent PCI for ACS, the incidence of short- (≤30 days) and long-term (>30 days after admission) clinical events (composite of myocardial infarction, cerebrovascular disease, coronary revascularisation, all-cause readmission, and mortality) and first non-fatal cardiovascular events were compared in groups.
At the time of hospitalisation for PCI, 3,982 (73.7%) were on LLT (PRE-LLT), and 1,418 (26.2%) initiated LLT after admission (POST-LLT). Patients on PRE-LLT were significantly less likely to experience ACS before admission for PCI than were those commencing LLT after discharge (PRE-LLT 32.3% vs POST-LLT 56.9%; p<0.001), even after matching for baseline risk factors. Among these patients with ACS, patients on PRE-LLT were older than those on POST-LLT (mean 69.5±9.5 vs 65.0±10.0 years; p<0.001), and had a higher prevalence of cardiovascular risk factors including diabetes (31.5% vs 9.6%; p<0.001), hypertension (79.7% vs 51.7%; p<0.001), and renal failure (7.6% vs 2.0%; p<0.001). No difference was observed between groups in the risk of short- or long-term (median 2.0 years; interquartile range 1.0-3.0) post-PCI cardiovascular (hazard ratio [HR] 1.08; 0.83-1.40; p=0.55) or overall clinical events (HR 1.11; 0.93-1.32; p=0.26).
In patients with coronary artery disease, the risk of ACS is reduced by early initiation of LLT before revascularisation is required. Long-term outcomes of patients at high risk prescribed LLT before admission for ACS PCI may not differ from those of patients at lower risk commencing LLT after PCI for ACS.
降脂治疗（LLT）已被确立为冠状动脉疾病患者管理的关键要素。然而，LLT起始时间对治疗结果的影响尚不清楚。
本研究比较了Advara心脏护理中心经皮冠状动脉介入治疗（PCI）登记处5433例患者的治疗结果，根据LLT起始时间分为PCI入院前或入院后。比较了各组中作为PCI指征的急性冠状动脉综合征（ACS）的患病率。在因ACS接受PCI的患者中，比较了短期（≤30天）和长期（入院后>30天）临床事件（心肌梗死、脑血管疾病、冠状动脉血运重建、全因再入院和死亡的综合）和首次非致命心血管事件的发生率。
在因PCI住院时，3982例（73.7%）正在接受LLT（LLT前），1418例（26.2%）在入院后开始接受LLT（LLT后）。LLT前的患者在PCI入院前发生ACS的可能性明显低于出院后开始LLT的患者（LLT前32.3% vs LLT后56.9%；p<0.001），即使在对基线风险因素进行匹配后也是如此。在这些ACS患者中，LLT前的患者比LLT后的患者年龄更大（平均69.5±9.5岁 vs 65.0±10.0岁；p<0.001），并且心血管危险因素的患病率更高，包括糖尿病（31.5% vs 9.6%；p<0.001）、高血压（79.7% vs 51.7%；p<0.001）和肾衰竭（7.6% vs 2.0%；p<0.001）。两组在PCI后短期或长期（中位2. Years；四分位间距1.0 - 3.0）心血管（风险比[HR]1.08；0.83 - 1.40；p = 0.55）或总体临床事件（HR 1.11；0.93 - 1.32；p = 0.26）风险方面未观察到差异。
在冠状动脉疾病患者中，在需要血运重建之前尽早开始LLT可降低ACS风险。在ACS PCI入院前接受LLT的高危患者的长期结果可能与ACS PCI后开始LLT的低危患者的结果没有差异。
