急性心肌梗死患者LDL-C阈值达到:一项证明PCSK9i强化治疗影响的真实世界证据研究
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
摘要
加拿大急性心肌梗死(AMI)患者中有很大比例未达到加拿大心血管协会2021年推荐的低密度脂蛋白胆固醇(LDL-C)阈值。这增加了随后发生动脉粥样硬化性心血管疾病(ASCVD)事件的风险。在这里，我们评估了ami后接受降脂治疗(LLT)的患者的LDL-C水平和阈值。方法:利用加拿大艾伯塔省的行政卫生数据库，对2015年至2019年确诊为AMI的患者进行回顾性队列研究。患者按ami后最高强度LLT分组(蛋白转化酶枯草杆菌素/酮素9型抑制剂(PCSK9i) +另一种LLT;PCSK9i孤独;依折麦布+他汀类药物;他汀类药物(高、中、低强度);或单独依折可布)，并在LLT配药日期前后一年检测可用LDL-C水平。结果:该队列包括15283例患者。在接受PCSK9i + LLT治疗的患者中，LDL-C水平中位数[95%置信区间(CI)]从治疗前的2.7 (2.3-3.4)mmol/l下降到治疗后的0.9 (0.5-1.2)mmol/l，是治疗组中下降幅度最大的。依zetimibe +他汀和高强度他汀组治疗后的中位(95% CI)值分别为1.5(1.5-1.6)和1.4 (1.4-1.4)mmol/l。治疗后，PSCK9i + LLT组低于1.8 mmol/l阈值的患者比例增加了77.7%，而依zetimibe +他汀和高强度他汀组分别为45.4和32.4%。结论:与单独使用他汀类药物和/或依折麦比相比，AMI患者使用PCSK9i强化可使更大比例的患者达到低于推荐的LDL-C阈值。增加对达到低于LDL-C阈值的关注，并根据需要进行额外的LLT，可能有利于患者的心血管预后。本文章由计算机程序翻译，如有差异，请以英文原文为准。
Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study Demonstrating the Impact of Treatment Intensification with PCSK9i.
Introduction: A high proportion of Canadian patients with acute myocardial infarction (AMI) do not achieve the threshold low-density lipoprotein cholesterol (LDL-C) levels recommended by the Canadian Cardiovascular Society in 2021. This increases the risk of subsequent atherosclerotic cardiovascular disease (ASCVD) events. Here, we assess LDL-C levels and threshold achievement among patients by lipid-lowering therapies (LLT) received post-AMI.
Methods: A retrospective cohort study of patients identified with AMI between 2015 and 2019 was conducted using administrative health databases in Alberta, Canada. Patients were grouped by their highest-intensity LLT post-AMI (proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) + another LLT; PCSK9i alone; ezetimibe + statin; statins (high, moderate, low intensity); or ezetimibe alone), and available LDL-C levels were examined in the year before and after LLT dispense date.
Results: The cohort included 15,283 patients. In patients on PCSK9i + LLT, the median [95% confidence interval (CI)] LDL-C levels decreased from 2.7 (2.3-3.4) before to 0.9 (0.5-1.2) mmol/l after treatment, the largest decrease among treatment groups. In the ezetimibe + statin and high-intensity statin groups, median (95% CI) values after treatment were 1.5 (1.5-1.6) and 1.4 (1.4-1.4) mmol/l, respectively. The proportion of patients below the 1.8 mmol/l threshold increased by 77.7% in the PSCK9i + LLT group after treatment, compared to 45.4 and 32.4% in the ezetimibe + statin and high-intensity statin groups, respectively.
Conclusions: Intensification with PCSK9i in AMI patients results in a greater proportion of patients achieving below the recommended LDL-C threshold versus statins and or ezetimibe alone. Increased focus on achieving below the LDL-C thresholds with additional LLT as required may benefit patient cardiovascular outcomes.
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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