急性冠状动脉综合征患者介入治疗后低密度脂蛋白胆固醇达标率及影响因素分析

Low-density lipoprotein cholesterol target goal attainment rate and related factors in patients with acute coronary syndrome after percutaneous coronary intervention

目的探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后低密度脂蛋白胆固醇（LDL-C）的达标率及其影响因素。方法回顾性分析2011年3月至2012年3月在大连医科大学附属第一医院心内科行PCI的ACS患者832例。以2011年欧洲心脏病学会和欧洲动脉粥样硬化学会血脂异常管理指南（欧洲指南）、2007年中国成人血脂异常防治指南及2012年中国经皮冠状动脉介入治疗指南（中国指南）为依据，评价ACS患者PCI术后1、9个月的LDL—C达标率，并采用多因素logistic回归分析其影响因素。结果根据欧洲指南，术后1、9个月LDL．C的达标率分别为25，2％（210／832）和22．2％（185／832）；根据中国指南，术后l、9个月LDL-C的达标率分别为46．5％（387／832）和42．3％（352／832）。按照中国指南标准进行多因素logistic回归分析显示，女性（OR=0．650，95％CI：0．442—0．956），年龄≥60岁（OR=0．628，95％CI：0．464-0．850）、高血压（OR=0．737，95％CI：0．547—0．994）、既往心肌梗死史（OR=0．696，95％c，：0．511—0．948）、既往PCI史（OR=0．575，95％CI：0．339—0．974）及术前基线LDL—C水平（OR=0．155，95％CI：0．096—0．252）是影响PCI术后1个月LDL—C达标率的独立影响因素；既往心肌梗死史（OR：0．706，95％CI：0．521—0．958）、既往PCI史（OR=0．565，95％CI：0．334—0．957）及术前基线LDL—C水平（OR=0．176，95％CI：O．110-0．282）是影响PCI术后9个月LDL．C达标率的独立影响因素。结论ACS患者PCI术后LDL-c达标率低，需要加强女性、老年、高血压、既往有心肌梗死、PCI史及基线LDL—C水平较高的ACS患者PCI术后的调脂治疗。

Objective To observe the low-density lipoprotein cholesterol （LDL-C） target goal attainment rate and related factors in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods From March 2011 to March 2012, a total of 832 ACS patients were retrospectively evaluated in the Cardiology Department of the First Affiliated Hospital of Dalian Medical University. The target goal attainment rate after PCI was defined as the percentage of patients reaching LDL-C goals recommended by The European Society of Cardiology （ESC） and the European Atherosclerosis Society （EAS） guidelines for the management of dyslipidemias （European guidelines ） and Chinese guidelines on prevention and treatment of dyslipidemias in adults and Chinese guidelines on percutaneous coronary artery intervention treatment （Chinese guidelines）. Multivariate logistic regression analysis was used to analyze the related factors. Results According to the European guidelines, the overall LDL-C goal attainment rates at 1 month and 9 months after PCI were 25.2% （210/832） and 22. 2% （186/832）, respectively. According to the Chinese guidelines, the overall LDL-C goal attainment rates at 1 month and 9 months after PCI were 46. 5% （387/832） and 42. 3% （352/832）, respectively. In accordance with the Chinese guidelines, the multivariate logistic regression analysis showed that gender （ females/males, OR =0. 650, 95% CI： 0. 442 - 0. 956）, age （ I〉 60 years/〈 60 years, OR = 0. 628, 95 % CI： 0. 464 - 0. 850）, hypertension （ OR = 0. 737, 95% CI： O. 547 - 0. 994）, prior myocardial infarction history （ OR = 0. 696, 95% CI：O. 511 - 0. 948 ）, prior PCI history （ OR = 0. 575, 95% CI： O. 339 - 0. 974） and baseline LDL-C levels （ OR = 0. 155,95% CI： O. 096 - 0. 252 ） were independent risk factors that affected LDL-C goal attainment at 1 month post PCI. Moreover, the following parameters were the independent risk factors for LDL-C goal attainment at 9 months after PCI： prior myocardial infarction history （ OR = 0. 706, 95% CI： 0. 521 -0. 958）, prior PCI history （ OR = 0. 565, 95% CI：O. 334 - 0. 957） and baseline LDL-C levels （OR = 0. 176, 95% CI：O. 110 -0. 282）. Conclusions Currently, the LDL-C control rate is low in patients with ACS after PCI. The cholesterol lowering therapy should be individually strengthened for patients after PCI, especially in female patients, patients with aged ≥ 60 years old, hypertension, prior myocardial infarction history, prior PCI history and higher baseline LDL-C level.