HMG-CoA還元酵素阻害剤スタチンによる冠動脈インターベンション後の長期予後改善効果

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Background: Recent clinical studies have demonstrated that lowering plasma cholesterol with HMG-CoA reductase inhibitors ("statins") improves morbidity and mortality in coronary heart disease. However, it has not yet been fully established whether statins can reduce restenosis and improve long-term clinical outcome after stenting. Methods: We examined 400 patients undergoing intracoronary ultrasound (ICUS) guided percutaneous coronary intervention (PCI) with stenting for the treatment of coronary artery disease. All 400 patients were assigned to statin group (194-patients) or non-statin group (206-patients). The angiographic end-point was restenosis (≧50% diameter stenosis by Quantitative Coronary Angiography [QCA]) and the clinical end-point was major adverse cardiac events (MACE; death, MI, CABG, re-PCI,) at 3-year follow-up. Results: No significant differences in gender, age, anginal symptoms, or distribution of diseased vessels were found between the two groups. At base line, total cholesterol (TC) levels in the statin group were significantly higher than those in the non-statin group (208±33mg/dl vs 195±30mg/dl, p<0.05), but low-density lipoprotein cholesterol (LDL-C) levels were almost the same (129±29mg/dl vs 125±29mg/dl, p=ns). However, at follow-up, these values were similar between the two groups. Significant lipid lowering was observed in the statin group. Vessel size (RD pre) was similar between statin and non-statin groups (statin group 2.47±0.46mm vs non-statin group 2.53±0.56mm). MLD pre, MLD post and MLD follow-up were also similar between statin and non-statin groups. Restenosis rate was not different between the two groups (statin group 18% vs non-statin group 24%). Three-year clinical follow-up rate was 100% in each group. The incidence of MI and over all death was significantly higher in non-statin group than that in statin group. Conclusion: Although statin therapy failed to show significant reduction of restenosis, it showed more favourable clinical outcomes associated with lower incidence of MI, over all death and PCI for new lesions during 3-year follow-up. Statins could improve long-term clinical outcome following the stent implantation.
愛知医科大学の論文
2005-12-15

HMG-CoA還元酵素阻害剤スタチンによる冠動脈インターベンション後の長期予後改善効果

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