Purpose

To estimate the risk of recurrent cardiovascular events in a real-world population of very high-risk Korean patients with prior myocardial infarction (MI), ischemic stroke (IS), or symptomatic peripheral artery disease (sPAD), similar to the Further cardiovascular OUtcomes Research with proprotein convertase subtilisin–kexin type 9 Inhibition in subjects with Elevated Risk (FOURIER) trial population.

Methods

This retrospective study used the Asan Medical Center Heart Registry database built on electronic medical records (EMR) from 2000 to 2016. Patients with a history of clinically evident atherosclerotic cardiovascular disease (ASCVD) with multiple risk factors were followed up for 3 years. The primary endpoint was a composite of MI, stroke, hospitalization for unstable angina, coronary revascularization, and all-cause mortality.

Results

Among 15,820 patients, the 3-year cumulative incidence of the composite primary endpoint was 15.3% and the 3-year incidence rate was 5.7 (95% CI 5.5–5.9) per 100 person-years. At individual endpoints, the rates of deaths, MI, and IS were 0.4 (0.3–0.4), 0.9 (0.8–0.9), and 0.8 (0.7–0.9), respectively. The risk of the primary endpoint did not differ significantly between recipients of different intensities of statin therapy. Low-density lipoprotein cholesterol (LDL-C) goals were only achieved in 24.4% of patients during the first year of follow-up.

Conclusion

By analyzing EMR data representing routine practice in Korea, we found that patients with very high-risk ASCVD were at substantial risk of further cardiovascular events in 3 years. Given the observed risk of recurrent events with suboptimal lipid management by statin, additional treatment to control LDL-C might be necessary to reduce the burden of further cardiovascular events for very high-risk ASCVD patients.

中文翻译：

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接受他汀类药物治疗的韩国心血管疾病患者的心血管事件发生率：使用电子病历数据从真实世界人群中估算

目的

评估既往有心肌梗死 (MI)、缺血性卒中 (IS) 或有症状的外周动脉疾病 (sPAD) 的高危韩国患者现实世界人群中心血管事件复发的风险，类似于进一步的心血管结局在高风险受试者 (FOURIER) 试验人群中使用前蛋白转化酶枯草杆菌蛋白酶–kexin 9 进行抑制研究。

方法

这项回顾性研究使用了牙山医疗中心心脏登记数据库，该数据库建立在 2000 年至 2016 年的电子病历 (EMR) 基础上。对具有临床明显动脉粥样硬化性心血管疾病 (ASCVD) 病史且具有多种危险因素的患者进行了为期 3 年的随访。主要终点是 MI、卒中、因不稳定型心绞痛住院、冠状动脉血运重建和全因死亡率的复合终点。

结果

在 15,820 名患者中，复合主要终点的 3 年累积发生率为 15.3%，3 年发生率为每 100 人年 5.7（95% CI 5.5-5.9）。在各个终点，死亡率、MI 和 IS 分别为 0.4 (0.3–0.4)、0.9 (0.8–0.9) 和 0.8 (0.7–0.9)。主要终点的风险在接受不同强度他汀类药物治疗的接受者之间没有显着差异。在随访的第一年，只有 24.4% 的患者达到了低密度脂蛋白胆固醇 (LDL-C) 目标。

结论

通过分析代表韩国常规实践的 EMR 数据，我们发现患有极高风险 ASCVD 的患者在 3 年内有进一步心血管事件的重大风险。鉴于观察到的他汀类药物脂质管理不佳的复发事件风险，可能需要额外的治疗来控制 LDL-C，以减轻极高危 ASCVD 患者进一步心血管事件的负担。