Circulation:冠状动脉疾病越严重,采用evolocumab治疗获益越大

2018-08-21 MedSci MedSci原创

近期,FOURIER试验(高风险患者应用PCSK9抑制剂的远期心血管预后研究)显示PCSK9抑制剂evolocumab可显著减少稳定型动脉粥样硬化血管疾病患者(包括既往发生过心肌梗死[MI]的患者)的主血管事件。研究人员推测在大量的有心肌梗死病史的患者中可能存在可鉴别应用evolocumab临床风险降低较明显的患者亚群的特征。研究人员根据最后一次心梗的时间、既往心梗的次数和是否存在多支参与冠脉病变

近期,FOURIER试验(高风险患者应用PCSK9抑制剂的远期血管预后研究)显示PCSK9抑制剂evolocumab可显著减少稳定型动脉粥样硬化血管疾病患者(包括既往发生过心肌梗死[MI]的患者)的主血管事件。研究人员推测在大量的有心肌梗死病史的患者中可能存在可鉴别应用evolocumab临床风险降低较明显的患者亚群的特征。

研究人员根据最后一次心梗的时间、既往心梗的次数和是否存在多支参与冠脉病变(2根及以上大血管动脉粥样硬化≥40%)对22351位既往心梗过的患者进行归纳。对比各个亚群之间应用evolocumab后大血管事件的相对和绝对风险的降低程度,包括主要结点(心源性死亡、MI、中风、因不稳定型心绞痛住院或冠状动脉重建)和次要结点(心源性死亡、MI或中风)。

8402位(38%)患者最近一次心梗是在两年内;5285位(24%)患者既往心梗≥2次;5618位(25%)患者残余多支冠状动脉病变。在同时包括3个高风险特征和其他初始协变量的多变量校正模型中,最后一次心梗时间越近、心梗次数越多以及残余多支冠状动脉病变仍是心血管预后的独立预测因子,主要结点的校正风险比(HRs)1.37(95% CI 11.22-1.53)、1.78(95% CI 1.59-1.99)和1.39(95% CI 1.24-1.56)(p均<0.001)。采用evolocumab治疗,高危组主要结点的相对风险降低最明显,近期心梗、多次心梗和残余多支冠状动脉病变的亚群相对风险分别降低20%(HR 0.80,95% CI 0.71-0.91)、18%(HR0.82,95% CI 0.72-0.93)和21%(HR 0.79,95% CI 0.69-0.91),而对于无近期心梗、无多次心梗和无残余多支冠脉病变的患者,相对风险仅分别降低5%(HR 0.95,95% CI 0.85-1.05)、8%(HR 0.92,95% CI 0.84-1.02)和7%(HR 0.93,95% CI 0.85-1.02)。鉴于起始风险较高,第3年时,高风险组绝对风险降低超过3%(3.4%、3.7%和3.6%),而低风险组仅降低约1%(0.8%、1.3%和1.2%)。

近期发生过心肌梗死、既往多次心肌梗死或残余多支冠状动脉病变的患者发生大血管事件的风险高,采用evolocumab治疗可大幅度降低该风险,同时可降低其血浆低密度胆固醇

原始出处:


Marc S. Sabatine,et al. Clinical Benefit of Evolocumab by Severity and Extent of Coronary Artery Disease. Circulation. 2018;138:756-766

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    2018-08-22 hwqiang

    学习啦

    0

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    2018-08-21 医者仁心5538

    学习了

    0

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    2018-08-21 王秀

    学习了,涨知识了!

    0

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Med Sci Monit:乔松素预处理对缺血再灌注和心律失常后大鼠心肌Cx43蛋白表达的影响

心肌梗死常诱发心律失常,缺血再灌注可加重心肌损伤。有研究表明乔松素可缓解脑缺血和降低心肌梗死面积。因此,本研究通过建立大鼠心肌I/R模型并评估乔松素对室性心律失常和缝隙连接蛋白Cx43表达的影响。

NEJM:II型糖尿病人群通过正规治疗可有效降低其死亡及心血管事件风险

研究认为,各项指标均得到有效控制的II型糖尿病患者其全因死亡、心肌梗死以及中风风险与一般人群相当,这一研究结果再次强调了糖尿病人群接受正规治疗的重要性

Circulation: 地区经济水平影响心肌梗死预后

在急性心肌梗死(MI)发作后,生活在贫困地区的患者通常面临预后不佳的问题。目前,关于地区经济地位(SES)是否会影响MI患者住院治疗效果,仍没有统一的结论。