Background Whether use of high-intensity statins is more important than achieving low-density lipoprotein cholesterol ( LDL -C) target remains controversial in patients with coronary artery disease. We sought to investigate the association between statin intensity and long-term clinical outcomes in patients achieving treatment target for LDL -C after percutaneous coronary intervention. Methods and Results Between February 2003 and December 2014, 1746 patients who underwent percutaneous coronary intervention and achieved treatment target for LDL -C (<70 mg/dL or >50% reduction from baseline level) were studied. We classified patients into 2 groups according to an intensity of statin prescribed after index percutaneous coronary intervention: high-intensity statin group (atorvastatin 40 or 80 mg, and rosuvastatin 20 mg, 372 patients) and non-high-intensity statin group (the other statin treatment, 1374 patients). The primary outcome was a composite of cardiac death, myocardial infarction, or stroke. Difference in time-averaged LDL -C during follow-up was significant, but small, between the high-intensity statin group and non-high-intensity statin group (59±13 versus 61±12 mg/dL; P=0.04). At 5 years, patients receiving high-intensity statins had a significantly lower incidence of the primary outcome than those treated with non-high-intensity statins (4.1% versus 9.9%; hazard ratio, 0.42; 95% confidence interval, 0.23-0.79; P<0.01). Results were consistent after propensity-score matching (4.2% versus 11.2%; hazard ratio, 0.36; 95% confidence interval, 0.19-0.69; P<0.01) and across various subgroups. Conclusions Among patients achieving treatment target for LDL -C after percutaneous coronary intervention, high-intensity statins were associated with a lower risk of major adverse cardiovascular events than non-high-intensity statins despite a small difference in achieved LDL -C level.

译文

背景: 在冠心病患者中,使用高强度他汀类药物是否比实现低密度脂蛋白胆固醇 (ldl-c) 目标更重要仍存在争议。我们试图调查在经皮冠状动脉介入治疗后达到ldl-c治疗目标的患者中,他汀类药物强度与长期临床结局之间的关系。方法和结果在2003年2月和2014年12月中,对1746例接受经皮冠状动脉介入治疗并达到ldl-c治疗目标 (低于基线水平 <70 mg/dL或> 50%) 的患者进行了研究。我们根据经皮冠状动脉介入治疗后规定的他汀的强度将患者分为2组: 高强度他汀组 (阿托伐他汀40或80 mg,瑞舒伐他汀20 mg,372例患者) 和非高强度他汀组 (其他他汀治疗,1374例患者)。主要结局是心源性死亡、心肌梗死或卒中的复合结局.在高强度他汀组和非高强度他汀组之间,随访期间的时间平均ldl-c差异是显着的,但很小 (59 ± 13对61 ± 12 mg/dL; P = 0.04)。在5年时,接受高强度他汀类药物治疗的患者的主要结局发生率明显低于非高强度他汀类药物治疗的患者 (4.1% 与9.9%; 风险比,0.42; 95% 置信区间,0.23-0.79; P<0.01)。在倾向评分匹配 (4.2% 与11.2%; 风险比,0.36; 95% 置信区间,0.19-0.69; P<0.01) 和不同亚组之间的结果一致。结论在经皮冠状动脉介入治疗后达到ldl-c治疗目标的患者中,高强度他汀类药物的主要不良心血管事件风险低于非高强度他汀类药物,尽管ldl-c水平差异很小。

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