辛伐他汀早期治疗急性心肌梗死临床观察

Effectiveness of simvastatin in the treatment of acute myocardial infarction

目的 :探讨口服辛伐他汀早期治疗急性心肌梗死 (AMI)的作用。方法 :回顾性研究 176例胆固醇正常的AMI患者 ,在给予溶栓、抗血小板、抗凝和抗缺血治疗同时 ,其中 10 1例接受口服辛伐他汀 2 0mg d持续治疗至少 3个月 (辛伐他汀组 ) ,另 75例未接受辛伐他汀治疗 (非辛伐他汀组 )。随访观察两组患者首次入院后 1年的终点事件发生率〔死亡、再次非致死性AMI、再次经皮冠状动脉介入治疗 (PCI)、冠状动脉旁路移植术 (CABG)〕和再入院率。结果 :辛伐他汀组与非辛伐他汀组比较 :1个月的死亡率 (4.95 %∶14 .6 7%P <0 .0 5 ) ,1年的死亡和再次非致死性AMI复合发生率 (10 .89%∶2 2 .6 7%P <0 .0 5 )、心绞痛发生率 (13.86 %∶2 7.0 2 % ,P <0 .0 5 )、再次PCI或CABG率 (8.90 %∶2 1.33% ,P <0 .0 5 )、再入院率 (14 .85 %∶2 8.0 0 % ,P <0 .0 5 )均显著降低 ,无肌病和严重肝功能损害。Logistic逐步回归分析表明 :高龄、左前降支病变、广泛前壁AMI与死亡、再次AMI和心绞痛复合终点发生率呈正相关 ,而左室射血分数、血管紧张素转换酶抑制剂、辛伐他汀、PCI则与之呈负相关。结论 :AMI胆固醇正常患者早期口服辛伐他汀 2 0mg d能减少 1年的死亡和心脏缺血事件发生率 ,用药安全。

Objective:To evaluate efficacy of simvastatin treatment in patients with AMI.Methods:One hundred and seventy six patients with AMI and normocholesterolemia who received thrombolysis, antiplatelet, anticoagulant, antianginal and PCI therapies were divided into two groups: simvastatin group consisted of 101 patients who received simvastatin 20 mg/d lasting at last 12 week and no simvastatin group consisted of 75 patients.The ocurrences of death, recurrent AMI, angina, repeat PCI, CABG and readmission were assessed during one year.Results:The incidence of death in one month was lower in the simvastatin group than in the no simvastatin group ( 4.95 % vs 14.67 %, P< 0.05 ), The composite endpoint of death or recurrent AMI ( 10.89 % vs 22.67 %, P< 0.05 ), angina pectoris ( 13.86 % vs 27.02 % ,P< 0.05 ), repeat PCI or CABG( 8.90 % vs 21.33 %, P< 0.05 ) and readmission ( 14.85 % vs 28.00 %, P< 0.05 ) in one year were lower in the simvastatin group than in the no simvastatin group. Old age, LAD disease, extensive anterior MI had positive relationship with the composite and point death, recurrent AMI or angina pectoris; but LVEF, ACEI, simvastatin or PCI therapies had negtive relationship with the composite endpiont of death, recurrent AMI or angina pectoris.Conclusion:Simvastatin associated with antiplatelet, anticoagulant, antiischemic and PCI therapies significantly decrease the incidence of adverse cardiac events in patients with AMI and normocholesterolemia in one year.