| Objective To analyze retrospectively the first time of major Adverse Cardiac events in patients with acute Myocardial myocardial infarction(AMI)who were successfully treated with percutaneous coronary intervention(PCI).To study the effect of statin compliance on recurrent MACE.Methods A retrospective follow-up study was carried out on the patients who successful received PCI treatment due to primary AMI in the Department 4 of Cardiology,Affiliated Zhongshan Hospital of Dalian University,from March 2010 to September 2015.A total of 468 patients were recruited in this study,and divided into 2 groups on the basis of proportion of days covered(PDC)with statins which was measured by the number of dispensed statin prescriptions during the interval between the date of the first statin prescription and the end of follow-up:statin continuous medication group(PDC≥90%)(n = 222)and non-sustained group(PDC<90%)(n =246).SPSS 19.0 statistical software was used to study the baseline data of patients.The measurement data were measured by independent sample t-test,and the count data were checked by chi-square test.The baseline data and the endpoint events were compared between the two groups.Single factor analysis with log-rank test was used to select independent variables with statistical significance for multivariate COX regression model analysis,and the correlation between each variable and the occurrence of MACE was discussed.Results1.The general situation of follow-upAs of September 30,2017,a total of 468 patients were followed,including 333 males(71.2%)and 135 females(28.8%),ranging in age from 30 to 93(64.47±11.63).Follow-up time(6-90)(42.45± 19.49)months.Among the follow-up patients,222 cases were non-sustained medication group,accounting for 47.4%of the total,including 154 malesnd and 68 females,accounting for 46.2%of the total males and 50.4%of the total females respectively.Among them,less than 65 years old,65-75 years old,76-85 years old and older than 85 years old accounted for 2.9%、47.9%、59.0%and 50.0%of their respective age groups.2.Baseline data comparisonGeneral demographics(age,sex),past history(hypertension,diabetes,smoking history)and clinical characteristics(Killip grade,type of acute myocardial infarction,number of coronary lesions,left ventricular ejection fraction,blood pressure),Duration of hospital stay and follow-up time were not statistically different.In the laboratory examination,the levels of triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,,alanine aminotransferase,creatinine were also no statistical difference.3.Follow-up end of the incident occurredDuring the follow-up period,107 cases of MACE occurred for the first time.The total incidence of MACE was 22.86%,including 33 cases of death,48 cases of non-fatal myocardial infarction and 26 cases of acute cerebrovascular events.The non-fatal myocardial infarction,acute cerebrovascular events,and total MACE occurence in the non-sustained medication group were significantly higher than those in the continuous medication group,(14.0%vs 6.9%,p=0.014;8.6%vs 2.8%,p=0.008,respectively).31.1%vs 15.4%,p<0.001).However,there was no significant difference in all-cause mortality between the two groups(8.6%vs 5.7%,p=0.278).4.Multiple regression analysis of major adverse cardiac eventsThe Kaplan meier survival curve was used to plot the cumulative survival function without MACE in both groups.The results showed that the statin continuous medication group had a significantly better prognosis than the non-sustained group.Univariate analysis suggested that age,hypertension,Killip classification,and number of coronary lesions were independent predictors of recurrent MACE.Multivariate COX regression analysis showed that statin therapy and LVEF were protective factors for MACE,while age was an independent predictor of non-fatal myocardial infarction and acute cerebrovascular events.After adjustment for related confounding factors,the risk of MACE,non-fatal myocardial infarction,and acute cerebrovascular events in the statin group was 0.527-fold,0.516-fold,and 0.367-fold,respectively,in non-sustained group.Conclusion:1.Non-sustained statin therapy is an independent predictor of major adverse cardiac events,non-fatal myocardial infarction and acute cerebrovascular events.2.Patients with acute myocardial infarction who underwent coronary intervention successfully discontinued or discontinued statins significantly increased major adverse cardiac events,including non-fatal myocardial infarction and acute cerebrovascular events. |
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