出院后停用他汀类药物治疗会增加老年急性心肌梗死患者远期死亡率：739例分析

Post-discharge statin withdrawal increase long-term mortality in elderly patients with acute myocardial infarction: analysis of 739 cases

摘要:

目的 探讨老年急性心肌梗死（AMI）患者出院后终止他汀类药物治疗对其远期预后的影响。方法 对解放军总医院心血管内科2010年1月至2010年12月期间确诊为AMI并行经皮冠状动脉介入治疗（PCI）且符合入选标准的老年患者739例进行出院后随访。根据患者出院后1年内是否终止他汀类药物治疗将其分为终止他汀类药物治疗组（n＝178）和未终止他汀类药物治疗组（n＝561），比较两组患者远期全因死亡率和心源性死亡率的差异。结果 对患者随访4年后发现，终止他汀类药物治疗的患者有更高的全因死亡率（21.4% vs 13.9%，HR＝1.62，95%CI：1.04～2.85，P＝0.008）和心源性死亡率（14.5% vs 8.1%，HR＝1.98，95%CI：1.26～3.64，P＝0.002）。结论 老年AMI患者出院后终止他汀类药物治疗会显著增加其远期死亡率，因此在患者出院前以及临床随访的过程中均需要对其他汀类药物的用药情况进行有效的教育和严格的监督，以期改善此类患者的远期生存情况。

Abstract:

Objective To determine the impact of post-discharge statin withdrawal on the long-term prognosis in the elderly patients after acute myocardial infarction (AMI). Methods A retrospective follow-up study was carried out on the elderly patients who received percutaneous coronary intervention (PCI) treatment due to AMI in the Department of Cardiology of our hospital from January 2010 to December 2010. A total of 739 patients were recruited in this study, and divided into 2 groups on the basis of statin withdrawal history: statin withdrawal group (n＝178) and continued statin therapy group (n＝561). The incidences of long-term all-cause mortality and cardiac mortality were compared between the 2 groups. Results After 4 years’ follow-up, the statin withdrawal group had significantly higher all-cause mortality (21.4% vs 13.9%, HR＝1.62, 95%CI: 1.04?2.85, P＝0.008), and obvious higher cardiac mortality (14.5% vs 8.1%, HR＝1.98, 95%CI: 1.26?3.64, P＝0.002) when compared with the continued statin therapy group. Conclusion Post-charge statin withdrawal greatly increases the long-term mortality in the elderly AMI patients after PCI treatment. So, effective education and strict supervision about statin therapy are needed for these elderly patients to improve their long-term survival situation.