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Abstract：
The aim of this retrospective study was to provide real-world data on lipid-lowering therapy (LLT) implementation and low-density lipoprotein cholesterol (LDL-C) target achievement in an ST-segment elevation myocardial infarction (STEMI) population, with a focus on very-high-risk patients according to European guidelines criteria.
METHODS: Included were all STEMI patients with available LDL-C and total cholesterol treated at a large tertiary center in Salzburg, Austria, 2018-2020 (n = 910), with stratification into very-high-risk cohorts. Analysis was descriptive, with variables reported as number, percentages, median, and interquartile range.
RESULTS: Among patients with prior LLT use, statin monotherapy predominated, 5.3% were using high-intensity statins, 1.2% were using combined ezetimibe therapy, and none were taking PCSK9 inhibitors at the time of STEMI. In very-high-risk secondary prevention cohorts, LLT optimization was alarmingly low: 8-22% of patients were taking high-intensity statins, just 0-6% combined with ezetimibe. Depending on the very-high-risk cohort, 27-45% of secondary prevention patients and 58-73% of primary prevention patients were not taking any LLTs, although 19-60% were actively taking/prescribed medications for hypertension and/or diabetes mellitus. Corresponding LDL-C target achievement in all very-high-risk cohorts was poor: <22% of patients had LDL-C values < 55 mg/dL at the time of STEMI.
CONCLUSIONS: Severe shortcomings in LLT implementation and optimization, and LDL-C target achievement, were observed in the total STEMI population and across all very-high-risk cohorts, attributable in part to deficits in care delivery.
METHODS: Included were all STEMI patients with available LDL-C and total cholesterol treated at a large tertiary center in Salzburg, Austria, 2018-2020 (n = 910), with stratification into very-high-risk cohorts. Analysis was descriptive, with variables reported as number, percentages, median, and interquartile range.
RESULTS: Among patients with prior LLT use, statin monotherapy predominated, 5.3% were using high-intensity statins, 1.2% were using combined ezetimibe therapy, and none were taking PCSK9 inhibitors at the time of STEMI. In very-high-risk secondary prevention cohorts, LLT optimization was alarmingly low: 8-22% of patients were taking high-intensity statins, just 0-6% combined with ezetimibe. Depending on the very-high-risk cohort, 27-45% of secondary prevention patients and 58-73% of primary prevention patients were not taking any LLTs, although 19-60% were actively taking/prescribed medications for hypertension and/or diabetes mellitus. Corresponding LDL-C target achievement in all very-high-risk cohorts was poor: <22% of patients had LDL-C values < 55 mg/dL at the time of STEMI.
CONCLUSIONS: Severe shortcomings in LLT implementation and optimization, and LDL-C target achievement, were observed in the total STEMI population and across all very-high-risk cohorts, attributable in part to deficits in care delivery.
摘要：
这项回顾性研究的目的是提供有关ST段抬高型心肌梗死（STEMI）人群的降脂治疗（LLT）实施和低密度脂蛋白胆固醇（LDL-C）目标实现的实际数据。根据欧洲指南标准，重点关注高危患者。
方法：包括在萨尔茨堡大型三级中心接受治疗的所有具有可用LDL-C和总胆固醇的STEMI患者，奥地利,2018-2020年（n=910），分层为极高风险队列。分析是描述性的，变量报告为数字，百分比,中位数，和四分位数范围。
结果：在先前使用LLT的患者中，他汀类药物单药治疗为主，5.3%使用高强度他汀类药物，1.2%的患者使用依泽替米贝联合治疗，并且在STEMI时没有服用PCSK9抑制剂。在非常高风险的二级预防队列中，LLT优化低得惊人：8-22%的患者服用高强度他汀类药物，只有0-6%与依泽替米贝结合。根据高危人群的不同,27-45％的二级预防患者和58-73％的一级预防患者没有服用任何LLT，尽管19-60％的人积极服用/处方治疗高血压和/或糖尿病的药物。在所有高危人群中，相应的LDL-C目标实现均较差：<22％的患者在STEMI时LDL-C值<55mg/dL。
结论：LLT实施和优化存在严重缺陷，和LDL-C目标实现，在整个STEMI人群和所有高危人群中观察到，部分原因是护理服务不足。
方法：包括在萨尔茨堡大型三级中心接受治疗的所有具有可用LDL-C和总胆固醇的STEMI患者，奥地利,2018-2020年（n=910），分层为极高风险队列。分析是描述性的，变量报告为数字，百分比,中位数，和四分位数范围。
结果：在先前使用LLT的患者中，他汀类药物单药治疗为主，5.3%使用高强度他汀类药物，1.2%的患者使用依泽替米贝联合治疗，并且在STEMI时没有服用PCSK9抑制剂。在非常高风险的二级预防队列中，LLT优化低得惊人：8-22%的患者服用高强度他汀类药物，只有0-6%与依泽替米贝结合。根据高危人群的不同,27-45％的二级预防患者和58-73％的一级预防患者没有服用任何LLT，尽管19-60％的人积极服用/处方治疗高血压和/或糖尿病的药物。在所有高危人群中，相应的LDL-C目标实现均较差：<22％的患者在STEMI时LDL-C值<55mg/dL。
结论：LLT实施和优化存在严重缺陷，和LDL-C目标实现，在整个STEMI人群和所有高危人群中观察到，部分原因是护理服务不足。
