A Retrospective Study Of Treatment Outcomes Of Different Lipid-lowering Regimens On Coronary Heart Disease Patients Undergoing Percutaneous Coronary Intervention

Objective:Numerous domestic and large scale, open, randomized, multicenterinternational clinical trials show that dyslipidemia is one of the major risk factors causingcoronary atherosclerosis heart disease (CHD). This study studied the real-world setting inclinical practice using five different lipid-lowering regimens, assessing the adversereaction and the major adverse cardiovascular event, to find a reasonable lipid-loweringregimen for secondary prevention of coronary heart disease (CHD) patients undergoingPCI．Methods:Using electronic medical records management system, patients hospitalizedin the cardiology department at the Second Affiliated Hospital of Soochow Universityfrom June2009to February2014diagnosed angiographically as coronary heart disease(CHD) positive and underwent subsequent PCI was included, with an exclusive criteria ofcardiac insufficiency, abnormal liver function, renal insufficiency, abnormal thyroidfunction, and malignant tumor. As a result,1172patients were included for this study.According to our real-world lipid-lowering regimens of secondary prevention for coronaryheart disease (CHD) undergoing PCI, patients were divided into five groups, respectively:lipitor20groups, namely the first group, patients taking Lipitor20mg QN (night)(Pfizer,drug name―atorvastatin calcium tablet‖); Crestor10groups, namely the second group,patients taking crestor10mg QN (AstraZeneca PLC, drug name "rosuvastatin calciumtablet"); Lipitor40groups, namely the third group, patients taking Lipitor40mg QN;Lipitor+Zetia groups, namely the fourth group, patients take20mg lipitor QN+Zetia10mg QD (once every day)(Merck production, drug name "Ezetimibe") and crestor+Zetia groups, namely the fifth group, patients taking crestor10mg QN+Zetia10mg QD.Prior to treatment, six and twelve months afterwards, extraction of venous blood, fastinghematic fat quadset (low-density lipoprotein cholesterol LDL-C, high-density lipoprotein cholesterol HDL-C, triglycerides TG, total cholesterol TC) were determined, as well asrenal function markers (creatinine Scr, uric acid UA), liver function markers (Aspartateaminotransferase AST, alanine aminotransferase ALT), and muscular system markers(creatine kinase CK) and inflammatory markers (C-reactive protein CRP), respectively.Primary endpoint events (death) and major adverse cardiovascular events (MACE) wererecorded.Results:1, Treatment of six months and twelve months after the five lipid-lowering regimenscan significantly lower levels of LDL-C (P0.05); five lipid-lowering regimens showedsignificant difference in lipid-lowering ability (P0.05), among which, lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD lead to most LDL-C decline,respectively,47.85%and34.54%、43.15%and42.43%, significantly greater than the otherthree lipid-lowering regimens (P0.05), but there was no statistically significantdifference between the two groups (P0.4108， P0.3092). Treatment of six monthsand twelve months later the lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD LDL-C showed decreased compliance rate than other lipid-loweringregimens, at70.59%and72.73%、71.88%and75.00%respectively, but there was nostatistically significant difference between the five groups (P0.05).2, Treatment six months and twelve months later lipitor20mg QN+Zetia10mg QDand crestor10mg QN+Zetia10mg QD TC and TG fell significantly lower than the otherthree lipid-lowering regimens (P0.05); lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD showed higher HDL-C rise than the other threelipid-lowering regimens, but there was no statistically significant difference (P0.05).3, After Six months treatment, five lipid solution showed incidence of adversereactions of7.09%,6.01%,4.35%,0and0. A total of41cases with adverse reactions wasobserved, including renal dysfunction (Scr increased1times more than the upper limit ofnormal ULN) in9cases (21.95%). Abnormal liver function (ALT, AST, increased3timesmore than the ULN) in14cases (34.14%). Abnormal muscle system (CK increased1timesmore than the ULN)18cases (43.91%). After twelve months treatment, the incidence ofadverse reactions were9.06%,2.30%,0,0and0. After twelve months treatment, adversereactions sumed up to a total of27cases, with kidney dysfunction in7cases (25.93%),abnormal liver function in9cases (33.33%), muscle abnormalities in11cases (40.74%). 4, After six months and twelve months treatment, lipid-lowering regimen lipitor20mgQN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD showed largest decline inCRP at21.57%and18.35%、17.71%and16.45%respectively, which are significantlygreater than the other three lipid-lowering regimens (P0.05).5, After six months treatment, incidence of MACE in Lipitor20mg QN+Zetia10mgQD and crestor10mg QN+Zetia10mg QD were1.18%and3.13%respectively, whichare lower than other lipid-lowering regimens; in which lipitor40mg QN lipid-loweringregimen had the largest incidence of MACE, at7.25%;12months after treatment, Lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD showed no MACE;lipitor40mg QN lipid-lowering regimen showed largest incidence of MACE, at20.00%.After treatment six months and twelve months, the MACE were41cases and41casesrespectively, of which the most common revascularization were27cases (65.85%) and34cases (82.93%) respectively.Conclusions:1, Treatment of six months and twelve months later, lipitor20mg QN+Zetia10mgQD and crestor10mg QN+Zetia10mg QD LDL-C decline and success rate weresignificantly greater than the other three lipid-lowering regimens, these lipid solutionseffect on reducing LDL-C was significantly more effective.2, Treatment of six months and twelve months later, five lipid-lowering regimens canreduce TC and TG levels, increase HDL-C levels, Lipitor20mg QN+Zetia10mg QD andcrestor10mg QN+Zetia10mg QD lipid-lowering regimens for the lower TC and TG, thehigher of HDL-C effect is better than the other three lipid-lowering regimens.3, Treatment of six months and twelve months later the lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD lipid-lowering regimens were less thanother lipid-lowering regimens on the incidence of adverse reactions; Patients withCoronary heart disease (CHD) undergoing PCI with abnormal liver function and themuscular system abnormalities were higher than renal dysfunction. Therefore, the use oflipid-lowering regimens should pay close attention to liver function and muscle systemfunction in patients with coronary heart disease undergoing PCI.4, Treatment of six months and twelve months later the Lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QD lipid-lowering regimens have the lowestincidence of major adverse cardiac events (MACE), lower than other lipid solution recurrence risk of cardiovascular events; The MACE have be observed, the highestoccurrence of reascularization, therefore, secondary prevention of coronary artery diseaseundergoing PCI to prevent stent restenosis and stent thrombosis specially.5, Lipitor20mg QN+Zetia10mg QD and crestor10mg QN+Zetia10mg QDlipid-lowering regimen have better anti-inflammatory effects.