依洛尤单抗对急性冠状动脉综合征患者经皮冠状动脉介入术后不良心血管事件的影响

Effect of evolocumab on major adverse cardiovascular events in patients with acute coronary syndrome treated with percutaneous coronary intervention

目的:探讨在他汀类药物应用基础上短期内使用依洛尤单抗能否降低急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)术后主要不良心血管事件(MACEs)的发生风险。方法:回顾性分析2019年1月—2019年10月于同济大学附属第十人民医院CCU收治的128例ACS患者为研究对象,根据是否使用依洛尤单抗分为试验组(41例)和对照组(87例),收集并比较两组患者人口统计学信息、实验室检查、基本临床信息、超声心动图结果、冠状动脉造影结果、基线血脂水平和PCI术后1个月血脂水平。对所有患者进行6个月随访,比较两组患者6个月MACEs发生情况,采用Kaplan-Meier生存分析法比较两组患者6个月随访期间MACEs和再发心肌梗死累积发生率。结果:试验组患者PCI术后1个月低密度脂蛋白胆固醇(LDL-C)水平显著低于对照组[0.83(0.54,1.54)mmol/L∶1.71(0.98,2.30)mmol/L,P=0.004]。经过6个月随访,试验组5例(12.2%)发生MACEs,对照组13例(14.9%)发生MACEs,两组患者在MACEs、死亡、卒中、靶血管再灌注等方面差异无统计学意义(P>0.05);其中试验组再发心肌梗死0例,对照组再发心肌梗死9例(10.3%),差异有统计学意义(P=0.027)。Kaplan-Meier生存分析显示两组患者累积再发心肌梗死发生率差异有统计学意义(Log-Rank检验P=0.039)。结论:ACS患者在他汀类药物应用基础上短期内使用依洛尤单抗能有效地降低LDL-C水平,同时能降低ACS患者PCI术后6个月再发心肌梗死风险。

Objective:To explore whether the short-term use of evolocumab based on the medication of statins can reduce the major adverse cardiovascular events(MACEs)after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods:One hundred and twenty-eight ACS patients who were admitted to the CCU of the Shanghai Tenth People’s Hospital from January 2019 to October 2019,were enrolled retrospectively.The patients were divided into the experimental group(n=41)and the control group(n=87)according to evolocumab administration.The demographic characteristics,laboratory data,basic clinical information,echocardiographic results,coronary angiography results and lipid profiles at baseline and 1 month after PCI were collected and compared between the two groups.All patients were followed up for 6 months.Kaplan-Meier survival analysis was used to compared the cumulative incidence of MACEs and recurrent myocardial infarction.Results:Patients in the experimental group had significantly lower low-density lipoprotein cholesterol(LDL-C)at 1 month after PCI compared with the control group[0.83(0.54,1.54)mmol/L:1.71(0.98,2.30)mmol/L,P=0.004\].During the 6-month follow-up,5(12.2%)patients in the experimental group and 13(14.9%)patients in the control group occurred MACEs.There was no statistically significant difference in MACEs,death,stroke,and target vessel reperfusion between two groups(P>0.05).And no one had recurrent myocardial infarction in experimental group and 9(10.3%)patients had recurrent myocardial infarction in control group(P=0.027).The Kaplan-Meier survival analysis showed that the incidences of cumulative recurrent myocardial infarction were different significantly between two groups(Log-Rank test P=0.039).Conclusion:Based on the medication of statins,the short-term use of evolocumab can reduce the level of LDL-C effectively,and also reduce the risk of recurrent myocardial infarction during the 6-month follow-up in ACS patients after PCI.