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Clinical outcomes with high-intensity statins according to atherothrombotic risk stratification after acute myocardial infarction: The FAST-MI registries.

根据急性心肌梗死后动脉粥样硬化血栓形成风险分层,高强度他汀类药物的临床结局: FAST-MI登记。

  • 影响因子:2.06
  • DOI:10.1016/j.acvd.2020.06.003
  • 作者列表:"Desjobert E","Tea V","Schiele F","Ferrières J","Simon T","Danchin N","Puymirat E","FAST-MI investigators.
  • 发表时间:2021-02-01
Abstract

BACKGROUND:Current guidelines strongly recommend high-intensity statin therapy after acute myocardial infarction. AIMS:To analyse the relationship between prescription of high-intensity statin therapy at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. METHODS:We used data from the FAST-MI 2005 and 2010 registries - two nationwide French surveys including 7839 consecutive patients with acute myocardial infarction. Level of risk was stratified in three groups using the TRS-2P score: Group 1 (low risk; TRS-2P=0-1); Group 2 (intermediate risk; TRS-2P=2); and Group 3 (high risk; TRS-2P≥3). RESULTS:Among the 7348 patients discharged alive with a TRS-2P available, high-intensity statin therapy was used in 41.3% in Group 1, 31.3% in Group 2 and 18.5% in Group 3. After multivariable adjustment, high-intensity statin therapy was associated with a non-significant decrease in major adverse cardiovascular events (death, stroke or recurrent myocardial infarction) at 5 years in the overall population compared with that in patients receiving intermediate- or low-intensity statins or without a statin prescription (14.3% vs 29.6%; hazard ratio 0.94, 95% confidence interval 0.81-1.09; P=0.42). In absolute terms, the decrease in major adverse cardiovascular events was positively correlated with risk level (Group 1: 8.1% vs 10.7%; Group 2: 14.8% vs 21.6%; Group 3: 30.8% vs 51.6%). However, after adjustment, the benefits of high-intensity statin therapy were associated with lower mortality only in high-risk patients (hazard ratio 0.79, 95% confidence interval 0.64-0.97; P=0.02). CONCLUSIONS:High-intensity statin therapy at discharge after acute myocardial infarction was associated in absolute terms with fewer major adverse cardiovascular events at 5 years, regardless of atherothrombotic risk stratification, although the highest absolute reduction was found in the high-risk TRS-2P class.

摘要

背景: 目前的指南强烈推荐急性心肌梗死后高强度他汀治疗。 目的: 根据急性心肌梗死后二级预防溶栓风险评分 (TRS-2P) 定义的风险水平,分析出院时高强度他汀治疗处方与长期临床结局的关系。 方法: 我们使用了来自FAST-MI 2005和2010登记系统的数据 -- 两项法国全国范围的调查,包括7839名连续的急性心肌梗死患者。使用TRS-2P评分对三组的风险水平进行分层: 组1 (低风险; TRS-2P = 0-1); 组2 (中等风险; TRS-2P = 2); 组3 (高风险; TRS-2P ≥ 3). 结果: 在7348例存活出院的TRS-2P患者中,高强度他汀类药物治疗在组1为41.3%,组2为31.3%,组3为18.5%。经过多变量调整后,高强度他汀类药物治疗与主要不良心血管事件 (死亡,卒中或复发性心肌梗死) 的非显著降低相关与接受中等或低强度他汀类药物或未接受他汀类药物处方的患者相比,总体人群5年时 (14.3% vs 29.6%; 风险比0.94,95% 置信区间0.81-1.09; P = 0.42)。就绝对值而言,主要不良心血管事件的减少与风险水平呈正相关 (组1: 8.1% vs 10.7%; 组2: 14.8% vs 21.6%; 组3: 30.8% vs 51.6%)。然而,经过调整后,高强度他汀类药物治疗的益处仅与高危患者较低的死亡率相关 (风险比0.79,95% 置信区间0.64-0.97; P = 0.02)。 结论: 急性心肌梗死后出院时高强度他汀类药物治疗与5年主要不良心血管事件较少相关,无论动脉粥样硬化血栓形成风险分层如何,尽管在高风险TRS-2P级中发现绝对降幅最高。

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