| 2 | 高脂血症患者中术前他汀类药物治疗与经皮冠状动脉介入术后所发生的院内并发症之间的关系显示文摘We investigated whether the observed protective effect of hyperlipidemia is stronger in patients who take statins and, if so, whether that effect is likely due to patient characteristics associated with statin use. In-hospital complications and long-term outcomes of patients with hyperlipidemia(cholesterol level ≥240 mg/dl) undergoing percutaneous coronary interventions(PCI) on statins(group Ia, n=2,052) and not on statins(group Ib, n=1,650) were compared with 726 patients with lower cholesterol levels(group Ⅱ). Despite a higher prevalence of co-morbidities and worse angiographic characteristics in patients with hyperlipidemia, patients in group Ia had significantly lower in-hospital mortality(0%vs 2%in the other 2 groups, p< 0.001), a lower increase in the postprocedure creatine kinase-MB fraction(14%vs 27%in group Ib and 28%in group Ⅱ, p< 0.001), and fewer PCI complications(15%vs 30%in groups Ib and Ⅱ, p< 0.001). After adjustment, patients in group Ia had a significant decrease in complications(odds ratio 0.72, 95%confidence interval 0.65 to 0.92, p=0.009). In contrast, those in group Ib had outcomes similar to those of patients with lower cholesterol. After application of propensity analysis to adjust for the likelihood of receiving statins based on clinical, angiographic, and procedural characteristics, group Ia had fewer in-hospital complications(odds ratio 0.75, 95%confidence interval 0.62 to 0.90, p=0.002) and lower in-hospital mortality(odds ratio 0.32, 95%confidence interval 0.12 to 0.84, p= 0.021). After successful PCI, overall survival after dismissal and survival free of myocardial infarction and target vessel revascularization were similar. In conclusion, hyperlipidemia per se is not associated with lower in-hospital complications after PCI. The benefit is largely limited to patients on statin treatment. | Singh M. Lennon R.J. Roger V.L. 杜媛 | 2006 | 世界核心医学期刊文摘(心脏病学分册)2006，，12： | 0 |
| 3 | 心肌梗死后卒中发生率的社区研究显示文摘Background: The rate of stroke after myocardial infarction (MI) remains unclear. Objectives: To examine the rate of stroke after incident MI; compare it with that observed in the population of Rochester, Minnesota; determine how the rate of stroke after MI has changed over time; and examine the impact of stroke on survival after incident MI. Design: Community-based cohort. Setting: Olmsted County, Minnesota. Participants: Persons with incident (first-ever) MI between 1979 and 1998. Measurements: Ischemic or hemorrhagic stroke in hospitalized and nonhospitalized patients that was identified by screening of the medical record for stroke diagnostic codes and subsequent stroke confirmation by physician review of the recorded event. Medical record review was used to ascertain baseline characteristics and death. Results: A total of 2160 persons with incident MI were hospitalized between 1979 and 1998 and followed for a median of 5.6 years (range, 0 to 22.2 years). The rate of stroke was 22.6 per 1000 person-months (95% CI, 16.3 to 30.6 per 1000 person-months) during the first 30 days after MI, corresponding to a 44- fold increase (standardized morbidity ratio, 44 [95% CI, 32 to 59]) risk for stroke in the population of Rochester, Minnesota. The risk for stroke remained 2 to 3 times higher than expected during the first 3 years after MI. Older age, previous stroke, and diabetes increased the risk for stroke, which did not decline over the study period. Strokes were associated with a large increase in the risk for death after MI (hazard ratio, 2.89 [CI, 2.44 to 3.43]). Limitations: Findings may not be generalizable to different populations. The authors measured outcomes by reviewing medical records. Conclusions: In the community, the risk for stroke is markedly increased after MI, particularly early after MI, compared with the expected risk in population without MI. Stroke is associated with a large increase in the risk for death after MI. | Witt B.J. Brown Jr. R.D. Jacobsen S.J. V.L. Roger 张平 | 2006 | 世界核心医学期刊文摘(神经病学分册)2006，2，4： | 0 |
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