急性冠脉综合征早期他汀类药物应用对住院和随访结果的影响

Impact of early statin therapy on inhospital and follow-up outcomes for acute coronary syndrome patients undergoing revascularization

目的：观察接受血运重建的急性冠脉综合征患者住院期间应用他汀类药物对预后的影响。方法：入选本院接受血管重建治疗并且低密度脂蛋白-胆固醇C〈100mg／dL的非ST段抬高急性冠脉综合征患者1121例，根据住院期间是否应用他汀类药物分为他汀组（668例）与非他汀组（453例）。主要不良心脑血管事件定义为死亡、新发心肌梗死、卒中和再次血管重建。结果：他汀组院内不良心血管事件发生率和随访病死率均明显降低（P〈0．05，P〈0．01），他汀组血管重建后累计病死率（院内及随访死亡）明显低于非他汀组（P〈0.01）。经Logistic多因素回归分析，住院期间是否应用他汀类药物与累计病死率显著相关（HR，0，471；95CI，0．245～0．906；P〈0．05），并且与随访病死率显著相关（HR，0．328；95CI，0．143～0．753；P〈0.01）。结论：住院期间应用他汀类药物可以显著减少急性冠脉综合征患者血管重建术后的住院不良心血管事件，降低累计病死率及随访病死率。

Objective To evaluate the effects of statin treatment initiated in hospital on acute coronary syndrome patients who received revascularization Methods Non-ST segment elevation on acute coronary syndrome patients who received revascularization in our hospital and whose low density lipoprotein cholesterol was lower than 100 mg/dL were included. These patients were divided into two groups, the statin group received statin therapy in hospital （n=668） and the no-statin group did not receive statin treatment （n=453）. The major adverse cardiovascular and cerebral vascular events were defined as mortality, acute myocardial infarction, revasualization and stroke. Results The occurrence of in-hospital major adverse cardiovascular and cerebral vascular events and the mortality in the follow-up period were significantly reduced in the statin group （P〈0.05, P〈0.01）. Cumulative mortality （in-hospital and follow-up period） also decreased in the statin-group（P〈0.01）. In logistic regression analysis, statin treatment initiated in hospital was associated with the reduction in cumulative mortality and mortality of the follow-up period （HR,0.471 ;95CI,0.245-0.906;P〈0.05 vs HR,0.328;95CI,0.143-0.753; P〈0.01）. Conclusion Early statin treatment in patients with non-ST segment elevation on acute coronary syndrome undergoing revascularization is associated with the reduction in hospital major adverse cardiovascular and cerebral vascular events and cumulative mortality and mortality of the follow-up period.