他汀类药物对颈动脉支架置入预后的影响

目的探讨应用他汀类药物对颈动脉支架置入术(CAS)预后的影响。方法回顾性分析2001年1月—2012年8月,在首都医科大学宣武医院神经外科实施CAS治疗的患者1700例,按是否服用他汀类药物分为他汀组1224例和非他汀组476例。降脂目标为将低密度脂蛋白胆固醇(LDL-C)水平降至2.1 mmol/L或降低基础水平的40%。比较两组患者术后30 d内卒中、心肌梗死和死亡的总发生率,分析他汀类药物与不良事件发生的相关性及并发症的危险因素。结果支架置入技术成功率100%。(1)术后30 d内43例(2.53%)患者出现主要不良事件,其中卒中34例、心肌梗死1例、死亡8例,应用他汀组术后主要不良事件发生率为1.96%(24/1224),而非他汀组术后主要不良事件发生率为3.99%(19/476),两组差异有统计学意义(χ2=5.731,P=0.017)。两组卒中发生率分别为1.56%(19/1224)和3.16%(15/476),差异有统计学意义(P0.05)。(2)围手术期服用他汀类药物是CAS良好预后的保护性因素(OR=0.524,95%CI:0.279~0.983;P=0.044)。结论 CAS的预后他汀治疗组术后主要不良事件发生率低于非他汀治疗组,他汀治疗可降低不良终点事件的发生率。

Effects of statins on the prognosis of carotid artery stenting

Objective To investigate the effects of statins application on the prognosis of carotid artery stenting（CAS）. Methods A total of 1700 patients who successfully performed carotid artery stenting at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from January 2001 to August 2012 were analyzed retrospectively.They were divided into either a statin group （n=1224） or a non-statin group （n=476） according to whether they took statins or not.The lipid-lowering target was to decrease the level of low-density lipoprotein cholesterol （LDL-C） to 〈2.1 mmol/L or decrease 40% of the basal level.The overall incidence of stroke,myocardial infarction and death at 30 day after procedure were observed in patients of both groups.The correlation between statins and the occurrence of adverse events,as well as the risk factors of complication were analyzed. Results The technical success rate of stenting in this group was 100%.（1）Forty three patients （2.53%） had major adverse events within 30 days after procedure,including 34 strokes,1 myocardial infarction,and 8 deaths.The major adverse event rate was 1.96% （24/1224） in the statin group,while it was 3.99% （19/476） in the non-statin group.There was significant difference （χ2=5.731,P=0.017）.The incidences of stroke in the two groups were 1.56%（19/1224） and 3.16%（15/476） respectively.There was significant different （P〈0.05）.（2）The perioperative administration of statins was a protective factor for the good prognosis of CAS （OR=0.524,95%CI 0.279 to 0.983;P=0.044）.The modified Rankin scale （mRS） score ≥3 （OR=3.025,95%CI 1.353 to 6.763） was a risk factor for occurring complications in patients with carotid artery stenting within 30 days after procedure. Conclusion The incidence of major adverse events of the statin group is lower than that of the non-statin group.Statin therapy may reduce the incidence of adverse outcome events.