Risk Differences in Secondary Prevention Patients Who Present With Acute Coronary Syndrome and Implications of Guideline-Directed Cholesterol Management.
Risk Differences in Secondary Prevention Patients Who Present With Acute Coronary Syndrome and Implications of Guideline-Directed Cholesterol Management.
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DOI：
10.1016/j.amjcard.2020.07.039
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发表时间：
2020-10-15
期刊：
影响因子：
--
通讯作者：
Stone NJ
中科院分区：
文献类型：
--
作者：
Kong NW;Bavishi A;Amaral AP;Tibrewala A;Jivan A;Silberman P;Stone NJ
2018年美国心脏病学会/美国心脏协会二级预防胆固醇指南确定了一组“非常高风险”(VHR)患者，即那些有多个重大动脉粥样硬化性心血管疾病(ASCVD)事件或1个具有多个高风险特征的重大ASCVD事件的患者。第二组，“高风险”(HR)，被定义为VHR组中没有任何风险特征的患者。这两组患者在非试验人群中的发病率和相对风险差异尚未得到很好的描述。使用西北医药企业数据仓库，我们比较了VHR和HR患者的发病率，以及他们在单中心、大型、学术和回溯性队列研究中心血管发病率和死亡率的相对风险。从2014年1月到2016年12月，共有1483名急性冠状动脉事件患者被分为VHR组和HR组。使用国际疾病分类第9版和第10版评估不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死、缺血性中风或全因死亡的复合事件，中位随访时间为3.3年。VHR患者每千人年有87±5.4个复合事件，而HR患者每千人年有33±5.1个事件(p<；0.001)。与HR组相比，VHR组发生未来事件的风险增加(多变量调整危险比1.66[1.01至2.74]，p=0.047)。总之，这些结果支持将患者分层为VHR和HR风险组以进行二级预防。
The 2018 American College of Cardiology/American Heart Association cholesterol guidelines for secondary prevention identified a group of “very high risk” (VHR) patients, those with multiple major atherosclerotic cardiovascular disease (ASCVD) events or 1 major ASCVD event with multiple high-risk features. A second group, “high risk” (HR), was defined as patients without any of the risk features in the VHR group. The incidence and relative risk differences of these 2 groups in a nontrial population has not been well characterized. Using the Northwestern Medicine Enterprise Data Warehouse, we compared the incidence of VHR and HR patients as well as their relative risk for cardiovascular morbidity and mortality in a single-center, large, academic, retrospective cohort study. Total 1,483 patients with acute coronary events from January 2014 to December 2016 were risk stratified into VHR and HR groups. International Classification of Diseases versions 9 and 10 were used to assess for composite events of unstable angina pectoris, non-ST elevation myocardial infarction, or ST-elevation myocardial infarction, ischemic stroke, or all-cause death with a median follow-up of 3.3 years. VHR patients were found to have 87 ± 5.4 composite events per 1,000 patient-years compared with HR patients who had 33 ± 5.1 events per 1,000 patient-years (p <0.001). VHR group had increased risk of future events as compared to the HR group (multivariable adjusted hazard ratio 1.66 [1.01 to 2.74], p = 0.047). In conclusion, these results support the stratification of patients into the VHR and HR risk groups for secondary prevention.
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