研究背景:近年之研究發現Statin藥物能改善接受冠狀動脈介入治療術患者之預後,然而國內迄今這方面之資料付諸闕如。本研究之目的即在探討現今國內急性心肌梗塞接受緊急冠狀動脈介入治療術患者使用Statin藥物之狀況以及連續服用Statin藥物對臨床預後的影響。 研究方法及研究結果:本研究回溯分析了240位(平均年齡61±13歲;男女比192/48因急性心肌梗塞入院且接受冠狀動脈介入治療術之患者。Statin藥物之使用與否取決於各處方之主治醫師。病人依是否連續使用Statin藥物分為兩組:連續服用Statin藥物者有149位,占62%未連續服用Statin藥物者有91位,占38%分析發現連續使用Statin藥物可顯著降低未來發生不良臨床事件之風險(連續服藥者之不良事件發生率為36%;未來連續服藥者為55%;P=0.019)。多變項分析校正各項可能影響預後之臨床指標後,連續服用Statin藥物者與未連續服用服藥者之危險比為0.60(95%信賴區間為0.41至0.90,P值為0.012)。 結論:急性心肌梗塞接受冠狀動脈介入治療術之患者連續使用Statin藥物可明顯降低日後發生不良臨床事件之風險。然而僅62%的使用率仍偏低,表示在實際臨床治療上提升Statin藥物的使用率,仍有值得努力的空間。
Purpose: Previous studies have suggested that the use of statins after percutaneous coronary intervention (PCI) is associated with better clinical outcomes. However, lipid-lowering treatment with statins is a neglected therapeutic approach in patients undergoing PCI in Taiwan. This study investigated the current status of statin use and the effect of statin treatment on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing emergency PCI. Methods: Two hundred and forty patients (aged 61±13 years, M/F=192/48) with AMI were enrolled. All of them underwent emergency coronary angiography and PCI. Patients were classified into 2 groups, those who were receiving continuous statin therapy (n=149, 62%) and those who were not (n=91, 38%). Cox proportional hazards model was performed to determine if continuous statin therapy was independently associated with a reduction in the risk of adverse clinical outcomes. Results: Our data demonstrated that continuous statin therapy was independently associated with a significant reduction (~35%) in the risk of adverse events (55% versus 36%; P=0.019). The adjusted odds ratio for the development of adverse events in patients receiving continuous statin therapy compared with patients who were not was 0.60 (95% CI, 0.41 to 0.90, P=0.012). Conclusion: Continuous statin therapy may reduce the risk of adverse clinical outcomes after PCI for AMI patients. However, the low use of statins (62%) in the study patients indicates that there is substantial room for improvement in implementation of statin therapy in AMI patients undergoing PCI.