冠状动脉支架置入术后1年内低密度脂蛋白胆固醇控制情况多中心随访研究

Control of LDL-C in coronary heart disease patients within 1 year after coronary stenting: A multicenter follow-up study

  • 摘要: 目的 分析患者冠状动脉支架置入术后1年内低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)控制情况,为合理干预提供依据。 方法 收集三家医院于2011年1月-2012年6月接受冠状动脉支架置入术患者术前基线资料及1年随访资料,分析各项血脂指标的控制、用药、饮食及运动情况。 结果 随访患者共1 274例,以2.08 mmol/L为LDL-C的目标值时,1个月、6个月、1年的未达标率分别为30.0%、36.3%、44.8%(P<0.05);以1.82 mmol/L为LDL-C的目标值时,1个月、6个月、1年的未达标率分别为45.7%、53.4%、58.6%(P<0.05)。6个月LDL-C不达标(≥2.08 mmol/L)患者,冠状动脉支架置入术后7个月~1年内主要心血管不良事件(major adverse cardiovascular events,MACEs)的发生率明显高于达标患者(7.5% vs 3.7%,P=0.000 8)。多元Logistic回归分析显示LDL-C不达标的主要危险因素为他汀类药物降脂方案未调整(OR=2.73,95% CI:1.89~3.57),基线LDL-C≥3.37 mmol/L (OR=2.28,95% CI:1.76~2.92),饮食控制不良(OR=1.65,95% CI:1.21~2.37),服药依从性差(OR=1.44,95% CI:1.09~2.15)。 结论 冠状动脉支架置入术后1年内,未达标患者MACEs发生率明显增高。

     

    Abstract: Objective To provide the evidence for rational intervention of LDL-C by analyzing its control in coronary heart disease(CHD) patients after coronary stenting. Methods Baseline data before coronary stenting and 1-year follow-up data(including serum LDL-C level, drugs used, diet, exercises) about patients who underwent coronary stenting in 3 hospitals from January 2011 to June 2012 were analyzed. Results A total of 1 274 patients were followed up. The abnormal LDL-C rate was 30.0%, 36.3%, 44.8% respectively when its target value was set at 2.08 mmol/L and 45.7%, 53.4%, 58.6% respectively when its target value was set at 1.82 mmol/L1, 6 and 12 months after coronary stenting(P<0.05). The incidence of major adverse cardiovascular events(MACEs) was significantly higher in patients with their LDL-C ≥ 2.08 mmol/L 6 months after coronary stenting than in those 7-12 months after coronary stenting(7.5% vs 3.7%, P=0.000 8). Multivariate logistic regression analysis revealed that non-adjusted lipid-decreasing statin therapy(OR=2.73, 95%CI:1.89-3.57), baseline LDL-C level ≥ 3.37 mmol/L(OR=2.28, 95%CI:1.76-2.92), poor diet control(OR=1.65, 95%CI:1.21-2.37) and poor medication compliance(OR=1.44, 95%CI:1.09-2.15) were the risk factors for abnormal LDL-C. Conclusion LDL-C is abnormal in a considerable number of patients 1 year after coronary stenting. The incidence of MACEs is high in patients with abnormal LDL-C.

     

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