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其影响因素

Low-density lipoprotein cholesterol compliance 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2月至2013年2月在湖北科技学院附属第一医院心内科行PCI的ACS患者416例。以2007年中国成人血脂异常防治指南及2012年中国PCI指南为依据,评价ACS患者PCI术后1月、9月的LDL-C达标率,并采用多因素Logistic回归分析其影响因素。结果根据指南,术后1月、9月LDL-C的达标率分别为46.4%和42.3%。多因素Logistic回归分析显示,女性、年龄≥60岁、高血压、既往心肌梗死史、既往PCI史和术前基线LDL-C水平是影响PCI术后1月LDL-C达标率的独立影响因素;既往心肌梗死史、既往PCI史和术前基线LDL-C水平是影响PCI术后9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） compliance rate and related factors in patients with acute coronary syndrome（ ACS） after percutaneous coronary intervention（ PCI）. Methods A total of 416 patients with ACS from February 2011 to February 2013 were retrospectively evaluated in the Department of Cardiology of the First Affiliated Hospital of Hubei University of Science and Technology. The complicance rate after PCI was defined as the percentage of patients reaching LDL-C goals recommended by Chinese guidelines on prevention and treatment of dyslipidemias in adults and Chinese guidelines on PCI treatment. Multivariate Logistic regression analysis was used to analyze the related factors. Results According to the chinese guidelines,the overall LDL-C compliance rates at 1month and 9 months after PCI were 46. 4%（ 193 /416） and 42. 3%（ 176 /416）. The multivariate Logistic regression analysis showed that gender（ females）,age（ ≥60 years）,hypertension,prior myocardial infarction history,prior PCI history and baseline LDL-C levels were independent risk factors that affected LDL-C compliance at 1 month after PCI. Moreover,the following parameters of prior myocardial infarction history,prior PCI history and baseline LDL-C levels were the independent risk factors for LDL-C compliance at 9 months after PCI. 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 aged≥60 years old,or those with hypertension,prior myocardial infarction history,prior PCI history or higher baseline level of LDL-C.