背景:目前的指南建议在接受过治疗的患者经皮冠状动脉介入治疗(PCI)后逐步开始降脂治疗。通过前期联合治疗,患者可能会从更早和更强的低密度脂蛋白胆固醇(LDL-C)降低中受益。
方法:这项回顾性研究包括2016年1月至2019年12月期间未接受过降脂治疗的急性或择期PCI支架植入术患者。开始使用他汀类药物单一疗法的患者与比较了他汀类药物和依泽替米贝的组合.主要终点是在3个月时LDL-C降低至<55mg/dL的目标范围。次要终点是主要心血管事件(MACE)的发生。
结果:共纳入204例未接受降脂治疗的患者,其中157人(77.0%)接受他汀单药治疗,47人(23.0%)接受联合治疗.接受联合治疗的患者的LDL-C中位数较高,而接受联合治疗的患者单一疗法(140mg/dL,四分位数间距,IQR,123-167mg/dLvs.102mg/dL,IQR80-136mg/dL,p<0.001)。与接受联合治疗的患者相比,LDL-C降低更大他汀类药物单一疗法(-73mg/dL,-52.1%vs.-43mg/dL,-42.2%,p<0.001)。而两组的主要终点相似(44.7%vs.36.1%,p=0.275),联合治疗显着增加了在存在入院LDL-C>120mg/dL的情况下达到治疗目标的患者比例(46.2%vs.26.2%,p=0.031)。两组的MACE发生率相似(10.6%vs.17.8%,p=0.237),中位随访时间为2.2年,IQR1.46-3.10年。
结论:立即开始高强度他汀类药物和依泽替米贝治疗可能被认为是接受PCI的高LDL-C患者的默认治疗策略。
BACKGROUND: Current guidelines recommend a stepwise initiation of lipid-lowering therapy after percutaneous coronary interventions (PCI) in treatment-naïve individuals. Patients might benefit from an earlier and stronger low-density lipoprotein-cholesterol (LDL-C) reduction through upfront combination therapies.
METHODS: This retrospective study included patients without previous lipid-lowering therapy undergoing acute or elective PCI with stent implantation between January 2016 and December 2019. Patients initiated on statin monotherapy vs. a combination of statin and ezetimibe were compared. The primary endpoint was an LDL‑C reduction into the target range of < 55 mg/dL at 3 months. The secondary endpoint was the occurrence of major cardiovascular events (MACE).
RESULTS: A total of 204 lipid-lowering therapy naive patients were included, of whom 157 (77.0%) received statin monotherapy and 47 (23.0%) combination therapy. Median LDL‑C levels were higher in patients initiated on combination therapy vs. monotherapy (140 mg/dL, interquartile range, IQR, 123-167 mg/dL vs. 102 mg/dL, IQR 80-136 mg/dL, p < 0.001). The LDL‑C reduction was greater in patients treated with combination therapy vs. statin monotherapy (-73 mg/dL, -52.1% vs. -43 mg/dL, -42.2%, p < 0.001). While the primary endpoint was similar between groups (44.7% vs. 36.1%, p = 0.275), combination therapy significantly increased the proportion of patients achieving the treatment target in the presence of an admission LDL-C > 120 mg/dL (46.2% vs. 26.2%, p = 0.031). The rates of MACE were similar between the two groups (10.6% vs. 17.8%, p = 0.237) at a median follow-up of 2.2 years, IQR 1.46-3.10 years.
CONCLUSIONS: Immediate initiation of high-intensity statin and ezetimibe treatment might be considered as the default strategy in treatment-naïve patients with high admission LDL‑C undergoing PCI.