Long-term benefit of statin therapy initiated during hospitalization for an acute coronary syndrome - A systematic review of Randomized trials
Long-term benefit of statin therapy initiated during hospitalization for an acute coronary syndrome - A systematic review of Randomized trials
复制标题
DOI：
10.2165/00129784-200707020-00005
复制
发表时间：
2007-01-01
影响因子：
3
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Bavry, Anthony A.;Mood, Girish R.;Bhatt, Deepak L.
目的：本研究旨在确定是否启动他汀类药物急性冠状动脉综合征期间使用他汀类药物（HMG-CoA还原酶抑制剂）治疗可降低长期死亡率和其他不良心脏结局。背景：在随访的4个月内，急性冠状动脉综合征期间开始使用他汀类药物治疗并未显示出降低死亡率、心肌梗死或卒中。急性冠脉综合征患者随机接受早期他汀类药物治疗与低强度降脂治疗的临床试验结果：总共有七项研究（L-CAD，PTT，佛罗里达，Colivicchi等人，PROVE-IT、ESTABLISH和A-to-Z），9553例患者在入院后12天内开始接受他汀类药物治疗。在22.9个月的加权平均随访中，他汀类药物组的全因死亡率为3.4%，而非强化降脂组为4.6%（相对风险[RR] 0.74; 95%CI 0.61，0.90; p = 0.003）。需要治疗以防止一例死亡的患者人数为84例。同样，他汀类药物组与强度较低的降脂组的心血管死亡率分别为2.4%和3.3%。（RR 0.74; 95% CI 0.58，0.93; p = 0.010），不稳定型心绞痛4.1% vs 5.0%（RR 0.81; 95% CI 0.68，0.98; p = 0.027），血运重建11.2% vs 12.9%（RR 0.86; 95% CI 0.78，0.96; p = 0.006），卒中1.1% vs 1.2%（RR 0.90; 95% CI 0.62，1.30; p = 0.56），心肌梗死6.6% vs 7.0%（RR 0.94; 95% CI 0.81，1.09; p = 0.41）。急性冠脉综合征早期开始他汀类药物治疗的益处随着时间的推移逐渐增加，因此在24岁左右可以看到生存优势。个月相对较少的患者需要治疗，以防止在这段时间内死亡。此外，这种方法显著减少了不稳定型心绞痛和血运重建的需要。
Objective: This study sought to determine if the initiation of statin (HMG-CoA reductase inhibitor) therapy during acute coronary syndromes reduces long-term mortality and other adverse cardiac outcomes.Background: Initiation of statin therapy during acute coronary syndromes has not been shown to reduce mortality, myocardial infarction or stroke within 4 months of follow-up.Methods: Clinical trials that randomized patients with acute coronary syndromes to early statin therapy compared with less intensive lipid reduction (placebo/lower-dose statin/usual care), and reported long-term outcomes were included for analysis.Results: In all, there were seven studies (L-CAD, PTT, FLORIDA, Colivicchi et al., PROVE-IT, ESTABLISH, and A-to-Z) with 9553 patients who started statin therapy within 12 days of hospital presentation. The incidence of all-cause mortality was 3.4% in the statin group versus 4.6% in the less intensive lipid reduction group over a weighted mean follow-up of 22.9 months (relative risk [RR] 0.74; 95% CI 0.61, 0.90; p = 0.003). The number of patients needed to treat to prevent one death was 84 patients. Similarly, the incidence of cardiovascular mortality in the statin versus the less intensive lipid reduction group was 2.4% versus 3.3% (RR 0.74; 95% CI 0.58, 0.93; p = 0.010), unstable angina 4.1% versus 5.0% (RR 0.81; 95% CI 0.68, 0.98; p = 0.027), revascularization 11.2% versus 12.9% (RR 0.86; 95% CI 0.78, 0.96; p = 0.006), stroke 1.1% versus 1.2% (RR 0.90; 95% CI 0.62, 1.30; p = 0.56), and myocardial infarction 6.6% versus 7.0% (RR 0.94; 95% CI 0.81, 1.09; p = 0.41).Conclusions: The benefit of early initiation of statin therapy during acute coronary syndromes slowly accrues over time so that a survival advantage is seen around 24 months. Relatively few patients need to be treated to prevent one death over this time period. Furthermore, this approach significantly reduces unstable angina and the need for revascularization.