冠状动脉支架置入术1年随访LDL-C控制及他汀使用情况:与新指南的距离

LDL-C control and statins administration during 1-year follow-up after coronary stent implantation: distance from new Blood Fat Treatment Guideline of America(2013)

目的分析冠状动脉支架置入术后1年随访时低密度脂蛋白胆固醇(LDL-C)控制及他汀使用情况,并与新指南对照。方法入选2010年9月至2012年12月在解放军第三〇六医院心血管内科行冠状动脉支架置入术患者539例,随访1年,收集复查资料,包括LDL-C水平及生化指标以及他汀类药物使用情况。结果治疗1年后,按2004年ACC/AHA血脂指南LDL-C水平,达标373例(69.2%),未达标166例(30.8%)。按2013年ACC/AHA新指南评价,LDL-C水平达标195例(36.1%),未达标344例(63.9%)。两种标准评价是否一致Kappa值为-0.047,P=0.178,两种标准比较存在明显统计学差异。他汀类药物治疗以阿托伐他汀(n=247,10 mg^80 mg)和瑞舒伐他汀(n=147,5 mg^20 mg)为主,其他还包括辛伐他汀(n=139,25.7%,10 mg^40 mg),氟伐他汀(n=2,40 mg),普伐他汀(n=4,40mg)。根据新指南中他汀类药物治疗强度,本研究中低强度降脂治疗21例(4.0%),中等强度512例(94.9%),高强度6例(1.1%),43例联合普罗布考治疗。结论按2013年新指南,冠状动脉支架置入术后他汀治疗1年,随访时多数患者LDL-C不达标,新指南是否适合中国人群需要进一步研究。

Objective To analyze LDL-C control and statins administration during 1-year follow-up after coronary stent implantation, and compared with new Blood Fat Treatment Guideline of America （2013, new guideline）. Methods The patients （n=539） underwent coronary stent implantation were chosen from Sept. 2010 to Dec. 2012, and followed up for 1 year for collecting reexamine data including LDL-C level, biochemical indexes and statins administration. Results After treatment for 1 year, there were 373 cases （69.2%） achieved target goal of LDL-C and 166 cases （30.8%） did not according to ACC/AHA guideline （2004）. There were 195 cases （36.1%） achieved target goal of LDL-C and 344 cases （63.9%） did not according to new ACC/AHA guideline （2013）. Kappa value was-0.047 （P=0.178）. The statins were mainly atorvastatin （n=247, 10 mg-80 mg） and rosuvastatin （n=147, 5 mg-20 mg）, and others included simuvastatin （n=139, 25.7%, 10 mg-40 mg）, fluvastatin （n=2, 40 mg） and pravastatin （n=4, 40 mg）. According to treatment intensity of statins in new guideline, there were 21 cases （4.0%） with low-intensity treatment, 512 cases （94.9%） with mid-intensity treatment and 6 cases （1.1%） with high-intensity treatment, and 43 cases were given statins combined probucol. Conclusion The level of LDL-C can not achieve target goal in most patients after coronary stent implantation and statins treatment for 1 year according the new guideline, so whether or not Chinese population is fit to the new guideline needs further study.