Xiaozhi Chen, Hangkuan Liu, Linjie Li, Geru A, Pengfei Sun, Doreen Su-Yin Tan, Mark Yan-Yee Chan, Roger Sik-Yin Foo, Gregg C Fonarow, Qing Yang, Xin Zhou
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引用次数: 0
摘要
背景：他汀类药物与肝脏相关不良事件相关，其风险因他汀类药物类型而异。然而，目前的指南缺乏对肝酶升高的急性心肌梗死（AMI）患者选择他汀类药物的具体建议。方法：本队列研究采用目标试验模拟方法，纳入中国天津健康与医疗数据平台2013年至2022年间接受经皮冠状动脉介入治疗的AMI患者。住院期间服用阿托伐他汀或瑞舒伐他汀处方的符合条件的患者分别使用肝酶升高和肝酶正常的倾向评分进行1:1匹配，并跟踪1年或直到死亡（意向治疗分析）。非依从性患者在每个方案分析中被删除。主要结局是1年全因死亡率，次要结局包括复发性心肌梗死和卒中。结果：在25,728例肝酶升高患者的匹配队列中，发生了614例死亡（2.4%）。与瑞舒伐他汀相比，阿托伐他汀与更高的全因死亡率相关（风险比[HR]: 1.29, 95%可信区间[CI] 1.10-1.51），在按方案分析中一致，并且在独立队列中证实了住院死亡率差异。复发性心肌梗死（HR: 0.98, 95% CI: 0.87-1.11）或卒中（HR: 1.10, 95% CI: 0.93-1.28）的发生率无显著差异。在18,270例入院时肝酶正常的AMI患者（每组9135例）中进行类似的目标试验模拟设计，发现两种他汀类药物在全因死亡率（HR: 1.09, 95% CI 0.88-1.35）、心肌梗死复发（HR: 1.05, 95% CI 0.90-1.23）或卒中（HR: 1.07, 95% CI 0.90-1.28）方面无显著差异。结论：在AMI后肝酶升高患者的靶试验模拟研究中，阿托伐他汀治疗与瑞舒伐他汀相比具有更高的1年全因死亡率风险。
Atorvastatin versus rosuvastatin in acute myocardial infarction with elevated liver enzymes: a target trial emulation study.
Background: Statins are associated with liver-related adverse events, with risk varying by statin type. However, current guidelines lack specific recommendations for statin selection in acute myocardial infarction (AMI) patients with elevated liver enzymes.
Methods: This cohort study used a target trial emulation approach to include AMI patients treated with percutaneous coronary intervention between 2013 and 2022 from the Tianjin Health and Medical Data Platform, China. Eligible patients with atorvastatin or rosuvastatin prescriptions during hospitalization were matched 1:1 using propensity scores in those with elevated liver enzymes and normal liver enzymes respectively, and tracked for 1 year or until death (intention-to-treat analysis). Nonadherent patients were censored in the per-protocol analysis. The primary outcome was 1-year all-cause mortality, with secondary outcomes including recurrent MI and stroke.
Results: In a matched cohort of 25,728 patients with elevated liver enzymes, 614 deaths (2.4%) occurred. Atorvastatin was associated with higher all-cause mortality compared to rosuvastatin (hazard ratio [HR]: 1.29, 95% confidence interval [CI] 1.10-1.51), consistent in the per-protocol analysis, and the in-hospital mortality difference was confirmed in an independent cohort. No significant differences were observed for recurrent MI (HR: 0.98, 95% CI 0.87-1.11) or stroke (HR: 1.10, 95% CI 0.93-1.28). Similar target trial emulation design among 18,270 AMI patients with normal liver enzymes at admission (9135 per group) found no significant differences between the two statins in all-cause mortality (HR: 1.09, 95% CI 0.88-1.35), recurrent MI (HR: 1.05, 95% CI 0.90-1.23), or stroke (HR: 1.07, 95% CI 0.90-1.28).
Conclusions: Atorvastatin treatment was associated with a higher risk of 1-year all-cause mortality than Rosuvastatin in a target trial emulation study of patients with elevated liver enzymes following AMI.
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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