JACC:冠脉钙化评分能“看穿”谁适合服用他汀?

2019-02-21 贾朝娟 环球医学

他汀对于心血管事件有强大的保护作用,冠状动脉钙化评分也能慧眼识别出从他汀治疗获益最大的目标人群吗?2018年12月,发表在《J Am Coll Cardiol》的一项研究对此进行了探究。

冠状动脉钙化预示着血管壁失去弹性且变得脆弱易破,发生危及生命的急性冠脉事件风险升高。早期发现冠状动脉钙化,尽早进行干预,方可挽救更多的生命。冠脉CT可以量化钙化的情况,即冠状动脉钙化评分。已经证实,与传统的风险因素相比,冠状动脉钙化评分预测动脉粥样硬化性血管疾病(ASCVD)结局更为准确。

他汀对于心血管事件有强大的保护作用,冠状动脉钙化评分也能慧眼识别出从他汀治疗获益最大的目标人群吗?2018年12月,发表在《J Am Coll Cardiol》的一项研究对此进行了探究。

美国学者对2002~2009年在沃尔特里德陆军医疗中心进行冠状动脉钙化评分且无ASCVD或恶性肿瘤的连续受试者进行了分析。

首要结局为首次发生严重不良心血管事件(MACE),定义为急性心肌梗死卒中和心血管死亡组成的复合结局。

在基于倾向得分使用治疗加权逆概率调整了基线合并症后,根据冠状动脉钙化评分存在与否和严重程度,分层分析他汀治疗对结局的影响。

总共13644名患者(平均50岁,男性71%),中位随访了9.4年。

根据有无他汀治疗和是否CAC分层,MACE的累积发生率

结果显示,在进行冠状动脉钙化评分的患者中,他汀暴露患者和不暴露患者相比,他汀治疗与MACE风险降低相关(调整子HR,0.76;95% CI,0.60~0.95;P=0.015),但无冠状动脉钙化评分患者并非如此(1.00;0.79~1.27;P=0.99)。

根据有无他汀治疗和状动脉钙化评分严重程度分层的MACE累积发生率

他汀对MACE的影响与冠状动脉钙化评分严重程度显着相关(P<0.0001),10年内预防1次MACE首次发作结局需治疗数范围为100(冠状动脉钙化评分为1~100)~12(冠状动脉钙化评分>100)。

因此,在这一基线无ASCVD的大样本队列中,冠状动脉钙化评分的存在与否及严重程度,可识别出最可能从他汀一级预防心血管疾病中获益的患者。

总体来讲,该研究结果支持心血管计算机断层扫描学会近期发布的共识声明,即冠状动脉钙化评分100应开始他汀治疗。但是,仍需要进一步研究来证实这些结果。

在进一步的研究结果公布之前,从普通人群中筛选可从他汀治疗最大程度获益的患者,阈值100可能也是一个合适的cutoff值。在与患者共同决策时,医务工作者应考虑心血管计算机断层扫描学会的声明,还有患者的总体风险状况,做出正确决策。

原始出处:

Mitchell JD, Fergestrom D, Gage BF, et al.Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring. J Am Coll Cardiol. 2018 Dec 25;72(25):3233-3242. doi: 10.1016/j.jacc.2018.09.051.

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    2019-04-17 hbwxf
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    2019-02-23 zhaojie88
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    2019-02-22 1209e435m98(暂无昵称)

    学习了,谢谢分享

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