Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.
Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.
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DOI：
10.1161/jaha.116.005333
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发表时间：
2017-04-12
影响因子：
5.4
通讯作者：
Henry TD
中科院分区：
文献类型：
--
作者：
Miedema MD;Garberich RF;Schnaidt LJ;Peterson E;Strauss C;Sharkey S;Knickelbine T;Newell MC;Henry TD
2013年美国心脏病学会/美国心脏协会胆固醇指南对注定要经历心血管疾病（CVD）事件的个体适格他汀类药物的影响尚不清楚。我们分析了来自区域性STEMI系统的连续ST段抬高型心肌梗死（STEMI）患者的前瞻性队列，包括患者人口统计学、低密度脂蛋白胆固醇水平、心血管疾病危险因素、药物使用和STEMI前2年的门诊就诊数据。我们根据美国心脏病学会/美国心脏协会指南和成人治疗小组指南的第三次报告确定了STEMI前的资格。我们的样本包括1062例患者，平均年龄为63.7（13.0）岁（72.5%为男性），761例（71.7%）在STEMI之前没有已知的心血管疾病。只有62.5%和19.3%的有和没有心血管疾病的患者在STEMI前分别服用他汀类药物。在未服用他汀类药物的个体中，有或没有已知CVD的低密度脂蛋白胆固醇水平中位数（四分位数范围）较低（108 [83,138]mg/dL和110 [87,133]mg/dL）。对于未服用他汀类药物的患者，只有38.7%的患者符合ATP III指南。相反，根据美国心脏病学会/美国心脏协会的指南，79.0%的患者符合他汀类药物的使用条件。有（49.2%）和无（41.1%）既往心血管疾病患者中，在STEMI发生前的2年内，只有不到一半的患者曾就诊于初级保健提供者。在一个大型STEMI患者队列中，应用美国心脏病学会/美国心脏协会指南的STEMI前他汀类药物资格比成人治疗小组指南第三次报告增加了一倍以上。然而，在STEMI之前，获得和利用卫生保健（指南实施的必要条件）是次优的。
The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. We analyzed a prospective cohort of consecutive ST‐segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low‐density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre‐STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low‐density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138] mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre‐STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.