经皮冠状动脉介入治疗后st段抬高型心肌梗死的阿托伐他汀预处理、st段消退及远期预后

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-09-19 DOI:10.1016/j.ijcha.2025.101808

Chao Wu , Pei Gao , Tiange Chen , Haiyan Xu , Xiang Li , Yan Wang , Honglei Zhao , Zhifang Wang , Guotong Xie , Yuejin Yang , Xiaojin Gao , Jingang Yang

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引用次数: 0

摘要

背景：st段抬高型心肌梗死（STEMI）经皮冠状动脉介入治疗（PCI）前他汀类药物预处理对心肌再灌注和预后的益处尚不清楚。在这项研究中，我们评估了阿托伐他汀预处理是否可以改善st段分辨率（STR）和这种情况下的长期临床结果。方法来自中国急性心肌梗死登记，我们对2426例接受初级PCI治疗的STEMI患者（每组1213例）进行倾向评分匹配，比较STR和2年主要不良心血管事件（MACE、全因死亡、再梗死和卒中）。结果预处理组中，分别有75例、726例、60例和691例患者接受了20 mg、40 mg、60 mg或80 mg的阿托伐他汀治疗。在可获得STR数据的2426例患者（1213例预处理）的匹配队列中，对照组258例（21%）患者发生了50%的STR，而预处理组159例（13%）患者发生了50%的STR（校正风险比[HR]: 0.53; 95% CI: 0.41-0.70）。多变量分析显示，阿托伐他汀预处理与较低的2年MACE发生率显著相关（6.9% vs 8.7%；调整HR: 0.68; 95% CI: 0.48-0.97），这在多个亚组中是一致的。结论首次PCI术前单剂量阿托伐他汀预处理可显著改善心肌再灌注参数，可能与长期临床获益相关，支持在随机试验中进一步验证。

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Atorvastatin pretreatment, ST-segment resolution and long-term prognosis for ST-segment elevation myocardial infarction with primary percutaneous coronary intervention

Background

The benefit of statin pretreatment before primary percutaneous coronary intervention (PCI) on myocardial reperfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) remains unclear. In this study, we evaluated whether atorvastatin pretreatment could improve ST-segment resolution (STR) and long-term clinical outcomes in this setting.

Methods

From the China Acute Myocardial Infarction Registry, we conducted propensity score matching to compare STR and 2-year major adverse cardiovascular events (MACE, all-cause death, reinfarction, and stroke) in 2426 STEMI patients undergoing primary PCI (1213 patients per group).

Results

Within the pretreatment group, 75, 726, 60, and 691 patients received 20 mg, 40 mg, 60 mg or 80 mg atorvastatin respectively. In the matched cohort of 2426 patients with available STR data (1213 pretreated), STR < 50 % occurred in 258 (21 %) patients in the control group versus 159 (13 %) in the pretreatment group (adjusted hazard ratio [HR]: 0.53; 95 % CI: 0.41–0.70). Multivariable analysis showed that atorvastatin pretreatment was significantly associated with lower 2-year MACE rates (6.9 % vs 8.7 %; adjusted HR: 0.68; 95 % CI: 0.48–0.97), which were consistent across multiple subgroups.

Conclusion

A single dose of atorvastatin pretreatment before primary PCI significantly improves myocardial reperfusion parameters and may be associated with long-term clinical benefits, supporting further validation in randomized trials.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.