| 【objective】In this study,patients undergoing percutaneous coronary intervention(PCI)were treated with initial medium-intensity statins plus ezetimib and medium-intensity statins alone.According to the standard defined by Chinese Expert Consensus on Lipid Management in Patients with ultra-high risk Atherosclerotic Cardiovascular Disease,the effects of two lipid-lowering regimens on short-term LDL-C achievement rates of ultra-high risk ASCVD patients were compared and observed,and to explore the optimized initial lipid-lowering regimen for ultra-high risk ASCVD patients with PCI.【Methods】A total of 204 patients(163 males and 41 females,mean age 67.29±11.37years)who underwent PCI in Department of Cardiology,967 Hospital of joint logistics support force of Chinese people’s Liberation Army from October 2019 to October 2020were enrolled.According to one-day or two-day admission,the patients’initial lipid-lowering regimen were randomly divided into two groups:medium-intensity statin monotherapy group(single-day admission,atorvastatin calcium 20mg or rosuvastatin 10mg,qd,n=106 cases)and medium-intensity statin plus ezetimibe combined group(double-day admission,atorvastatin calcium 20mg or rosuvastatin10mg combined with ezetimibe 10mg,qd,n=98 cases).The baseline data,LDL-C,creatine kinase(CK),alanine aminotransferase(ALT),blood glucose(Glu),glomerular filtration rate(EGFR)and other biochemical indexes of the two groups ultra-high risk patients were recorded.According to the 2020 CSC expert consensus definition of ultra-high risk ASCVD diagnostic criteria and LDL-C target value(LDL-C<1.4 mmol/L,and lower than the baseline by more than 50%),the LDL-C reaching standard rate at discharge,4 weeks and 8 weeks after discharge was compared between the two groups.【Results】1.The overall proportion of patients with ultra-high risk ASCVD in PCI patients:among 204 patients with PCI,152 patients(74.51%)met the definition of 2020 CSC expert consensus,72 were in the monotherapy group and 80 were in the combination group;2.Comparison of baseline data of ultra-high risk ASCVD patients between single drug group and combination group:male(76.4%vs.67.5%),age(66.82±11.97 vs.68.06±12.08),body mass index(25.12±3.00 kg/m~2 vs.25.19±2.56 kg/m~2),unstable angina pectoris(75.0%vs.63.1%),non ST elevation myocardial infarction(6.9%vs.12.5%),ST elevation myocardial infarction(15.3%vs.22.5%),hypertension(80.6%vs.78.8%),diabetes mellitus(45.8%vs.45.0%),old myocardial infarction(22.2%vs.26.5%),smoking history(52.8%vs.48.8%),A history of continuous(>1month)use of a single statin until 4 weeks prior to admission:atorvastatin(20.8%vs.22.5%),pitavastatin(5.6%vs.3.8%),rosuvastatin(8.3%vs.11.3%),LDL-C(2.36±0.71 mmol/L vs.2.53±0.75mmol/L),CK[77.8(57.0,125.5)U/L vs.97.6(65.4,172.8)U/L]、ALT[25.8(14.9,35.0)U/L vs.24.2(15.3,36.0)U/L]、Glu(5.42±1.26mmol/L vs.5.01±1.35mmol/L)、eGFR(86.53±16.13ml/min vs.86.35±19.09ml/min),LDL-C<1.4 mmol/L(5.6%vs.1.3%),atorvastatin(62.5%vs.72.5%),rosuvastatin(37.5%vs.27.5%),and average length of stay(4.63±1.07 vs.4.56±1.14),There was no significant difference in the above baseline data(P>0.05);3.The LDL-C values of ultra-high risk ASCVD patients in single drug group and combination group at discharge and at the 4th and 8th week after discharge were 2.01±0.55 mmol/L vs.1.87±0.49 mmol/L,1.89±0.50 mmol/L vs.1.60±0.47 mmol/L and 1.80±0.49 mmol/L vs.1.47±0.42mmol/L,respectively.There was significant difference between the two groups at the 4th and 8th week after discharge(P<0.05).4.Compared with the baseline,the LDL-C of ultra-high risk ASCVD patients in single drug group and combination group decreased by 22.08%vs.33.33%,25.89%vs.41.97%and 29.09%vs.46.21%at discharge and 4 weeks and 8 weeks after discharge,respectively.There were significant differences between the two groups(P<0.05).5.The LDL-C compliance rates of ultra-high risk ASCVD patients in single-drug group and combination group at discharge and 4th and 8th week after discharge were 1.4%vs.8.8%,6.9%vs.25.0%and 13.9%vs.36.3%,respectively.There was significant difference between the two groups at 4 and8 weeks after discharge(P<0.05).6.Comparison of other indexes of ultra-high risk ASCVD patients in single drug group and combination group at discharge and at the 4th and 8th week after discharge:(U/L):CK{[78.0(60.4,107.9)vs.78.0(54.0,109.0)];[71.5(56.0,113.3)vs.78.1(57.3,105.3)];[85.2(60.3,114.5)vs.83.2(57.5,123.1)]}、ALT{[25.9(17.0,37.5)vs.23(16.1,34.5)];[24.2(15.0,35.3)vs.23.0(14.6,34.6)];[23.4(15.2,32.3)vs.20.9(15.0,32.3)]}.There was no significant difference between the two groups(P>0.05).Within 8weeks after discharge,there were gastrointestinal reactions(5.6%vs.6.3%),new-onset diabetes or impaired glucose tolerance(1.4%vs.2.5%),myalgia(1.4%vs.1.3%),and moderate fatigue(4.2%vs.2.5%).There was no significant difference between the two groups(P>0.05).【Conclusion】1.The proportion of ultra-high risk patients meeting the 2020 CSC expert consensus definition among patients undergoing PCI was high,74.51%.2.The percentage of prehospital long-term statin lipid-lowering medication in ultra-high risk patients was low at only 36.18%.3.The ultra-high risk patients average level of LDL-C was 2.45±0.74 mmol/l at admissionin,and only 3.29%of patients with LDL-C<1.4mmol/l.4.Compared with the single drug lipid lowering regimen,the initial combined lipid lowering regimen could significantly improve the double standard rate of LDL-C at the4th and 8th week after PCI,and there was no increase of side effects.5.Even if the initial combined lipid reduction regimen is adopted,there are still 75%and 63.75%ultra-high risk ASCVD patients whose LDL-C is not up to standard at 4and 8 weeks after discharge.Further optimization schemes,including PCSK9inhibitors,should be considered for this group of patients. |
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