阿托伐他汀对冠心病并慢性心力衰竭及心房纤颤患者的预后研究

Effect of atorvastatin on the prognosis in patients with coronary heart disease complicated with chronic heart failure and atrial fibrillation

目的研究阿托伐他汀治疗对冠心病并慢性心力衰竭(CHF)及心房纤颤(AF)患者的影响。方法 62例冠心病并CHF及AF住院患者随机分成两组,他汀组32例,非他汀组30例,两组患者均常规抗心衰等治疗,而他汀组加用阿托伐他汀(立普妥)20 mg/d,分别随访1年,观察两组出院后不同类型房颤的复发及维持情况,评估随访1年内主要不良心血管事件(心血管死亡、非致死性心肌梗死及卒中)风险及心衰再住院率。结果治疗前两组在性别、年龄、并存疾病、AF类型、NYHA心功能分级、左室射血分数(LVEF)、左房内径(LAD)左室舒张末期内径(LVEDD)方面比较差异均无统计学意义(P>0.05)。随访期间主要心血管不良事件发生率他汀组和非他汀组比较差异无统计学意义(31.3%vs 53.3%,χ2=3.817,P=0.282);而他汀组的心衰再住院率减低(25.0%vs 50.0%,P=0.042);阵发性AF复发率他汀组较之非他汀组降低(28.1%vs 53.3%,P=0.043);但持续性房颤复发率两者差异无统计学意义(18.8%vs 20.0%,P=0.901)。结论阿托伐他汀可减少冠心病并CHF及AF患者的阵发性AF复发、降低心衰再住院率,但对主要心血管不良事件发生率无明显影响。

Objective To study the effects of the atorvastain on the prognosis in patients with coronary heart disease（CHD） complicated with chronic heart failure（CHF） and atrial fibrillation（AF）. Methods Sixty-two consecutive patients admitted for CHD complicated with CHF and AF were divided randomly into two groups： the statin group and the no-statin group. Patients of the both groups were treated with conventional medication of anti-heart failure,and patients in the statin group received additional atorvastatin 20 mg daily. Both groups were followed up for about one year. The recurrence and maintenance of different types of AF were observed after discharge. The risk of the major adverse cardiovascular events（MACE）, including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the rates of re-hospitalization for worsening heart failure were evaluated during 1-year follow-up. Results There were no significant differences between the two groups in gender, age, comorbidities such as hypertension and diabetes mellitus, the types of AF, NYHA cardiac functional grading, left ventricular ejection fraction（LVEF）, left atrial dimension（LAD）and left ventricular end-diastolic dimension（LVEDD）. The incidence of MACE during follow-up between the statin and the no-statin groups was of no significant difference（31.3% vs 53.3%, χ^2=3.817, P=0.282）. However, the readmissions rate for worsening HF in the statin group was significantly lower（25.0% vs 50.0%, P=0.042）. The recurrence rate of paroxysmal AF was lower in the statin group compared with the no-statin group（28% vs 53%, P=0.043）,whereas there was no significant difference of persistent AF between the two groups（18.8% vs 20.0%, P=0.901）.Conclusion Atorvastatin could reduce the incidence of recurrent paroxysmal AF and the readmission rate for HF in patients with CHD complicated with CHF and AF, whereas it had no significant effect on the incidence of MACE.