背景:急性心肌梗死(AMI)后的脂质管理是高心血管(CV)风险组二级预防的重要方面之一,而靶向降低低密度脂蛋白胆固醇(LDL-C)仍是心肌梗死(MI)后血脂治疗的主要目标.
目的:与2019年欧洲心脏病学会(ESC)血脂异常治疗指南相比,对进入三级护理中心的MI后患者的血脂管理的充分性进行回顾性研究。
方法:该研究是对在Ubora心脏服务下收治的MI患者的病历进行的回顾性回顾,内罗毕医院,从2020年1月到2022年6月。
结果:研究人群包括79名患者,平均年龄为59.3(SD±12),以男性为主(61例,77.2%),和非洲裔(60名患者,75.9%)。大多数研究人群出现ST段抬高型心肌梗死(STEMI)(62%),在这些患者中记录的6个最普遍的心血管危险因素是:50例(63.3%)患者的全身性动脉高血压;34例(43.0%)的血脂异常;25例(31.6)的II型糖尿病(T2DM);12例(15.2%)的吸烟史;12例(15.1%)的肥胖或超重;4例(5.1%)患者的早发冠心病或心源性猝死家族史.此外,88.6%的患者在入院后48小时内进行了血脂评估,平均LDL-C水平为3.18mmol/L(SD±0.18)。研究中招募的所有患者均开始使用高强度他汀类药物,包括40mg或80mg阿托伐他汀或20mg或40mg瑞舒伐他汀。招募的39名(44%)患者在随访中重复血脂谱,中位脂质分析时间为5个月(四分位数间距(IQR):2.0-10.0)。其中,只有6人(17.1%)达到LDL-C<1.4mmo/L的目标,而只有16人(45.7%)从基线LDL-C水平降低超过50%,3例(8.6%)患者的LDL-C水平较基线升高。总的来说,14.7%的研究患者达到了指南推荐的LDL-C目标,即LDL-C目标<1.4mmo/L,并且比基线LDL-C降低≥50%。经过五个月的随访,75例(94.9%)患者接受他汀类药物单药治疗,4例(5.1%)接受高强度他汀类药物和依泽替米贝联合治疗。
结论:这项回顾性研究强调了急性冠状动脉综合征(ACS)早期致敏和采用二级预防策略的必要性,根据2019年ESC指南的建议。
BACKGROUND: Lipid management after acute myocardial infarction (AMI) is one of the important aspects of secondary prevention in the high cardiovascular (CV) risk group, and targeted reduction of low-density lipoprotein cholesterol (LDL-C) remains the primary target for lipid therapy after myocardial infarction (MI).
OBJECTIVE: To conduct a retrospective
study of the adequacy of lipid management in post-MI patients admitted to a tertiary care centre as compared to the 2019 European Society of Cardiology (ESC) guidelines for the management of dyslipidaemia.
METHODS: The
study was a retrospective review of medical records of patients admitted with MI under the Ubora Heart Service, Nairobi Hospital, from January 2020 to June 2022.
RESULTS: The study population included 79 patients, with a mean age of 59.3 (SD ±12), predominantly male (61 patients, 77.2%), and of African descent (60 patients, 75.9%). The majority of the
study population presented with an ST-segment elevation myocardial infarction (STEMI) (62%), and the six most prevalent cardiovascular risk factors recorded amongst the patients were: systemic arterial hypertension in 50 (63.3%) patients; dyslipidaemia in 34 (43.0%); type II diabetes mellitus (T2DM) in 25 (31.6); history of smoking in 12 (15.2%); obesity or being overweight in 12 (15.1%); and family history of premature coronary artery disease or sudden cardiac death in four (5.1%) patients. Moreover, 88.6% of the patients had their lipid profile assessment done within 48 hours of admission, with a mean LDL-C level of 3.18 mmol/L (SD ±.18). All the patients recruited in the
study were started on high-intensity statins with either 40 mg or 80 mg of atorvastatin or 20 mg or 40 mg of rosuvastatin. Thirty-nine (44%) patients recruited had repeat lipid profiles on follow-up, with a median lipid analysis time of five months (interquartile range (IQR): 2.0-10.0). Of those, only six (17.1%) achieved the LDL-C goal of <1.4 mmo/L while only 16 (45.7%) achieved a greater than 50% reduction from their baseline LDL-C level, with three (8.6%) patients having an increased LDL-C level from baseline. Overall, 14.7% of the patients studied achieved the guideline-recommended LDL-C goal of an LDL-C target of <1.4 mmo/L and a ≥ 50% reduction from baseline LDL-C. After five months of follow-up, 75 (94.9%) patients were on statin monotherapy, with 4 (5.1%) on high-intensity statin and ezetimibe combination therapy.
CONCLUSIONS: This retrospective
study highlights the need for early sensitisation and the adoption of secondary prevention strategies in acute coronary syndrome (ACS), as recommended by the 2019 ESC guidelines.