Дозозависимый эффект предварительного лечения статинами на риск развития периоперационных осложнений стентирования сонной артерии


Дж.-Г. Хонг, С.-И. Сон, Дж. Квак, Дж. Йо, Г.В. Чанг, О.-К. Квон, К. Юнг, И. Чунг, Г.-Дж. Бае, Дж.С. Ли, М.-К. Хан

Department of Neurology; Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea; Department of Neurology, Department of Neurosurgery, Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Clinical Trial Center, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
Предпосылки и цель исследования. Мы изучили вопрос о влиянии предварительного лечения статинами на снижение риска развития осложнений в периоперационном периоде у пациентов, которым выполняют стентирование сонной артерии по поводу симптомного стеноза. Методы. В исследование зачислили 397 пациентов с симптомным стенозом сонной артерии (стеноз ≥50% по результатам рент­-
геновской ангиографии), которым выполнили стентирование сонной артерии в одной из 2 университетских специализированных клиник за 10-летний период. К осложнениям в периоперационном периоде относились: развитие инсульта, инфаркта миокарда или летального исхода в течение 1 месяца после или во время вмешательства. Пациентов разделили на 3 категории в зависимости от проведенного лечения статинами и в соответствии с эквивалентной дозой аторвастатина: отсутствие лечения (n=158, 39,8%), стандартная доза (до 40 мг­
аторвастатина, n=155, 39,0%) и высокая доза (≥40 мг, n=84, 21,2%). Для изучения независимых факторов риска развития осложнений в периоперационном периоде провели анализ многофакторной логистической регрессии с использованием метода общих оценочных уравнений. Результаты. Средний возраст пациентов составил 68,7 года (81,6% мужчин). Частота развития осложнений в периоперационном периоде в трех группах пациентов составила 12,0%, 4,5 и 1,2%. После внесения поправок изменение категории дозировки аторвастатина было ассоциировано с уменьшением риска развития осложнений (стандартная доза статинов: отношение шансов [ОШ]=0,24; 95% доверительный интервал [ДИ] от 0,07 до 0,81; высокая доза статинов: ОШ=0,11; 95% ДИ от 0,01 до 0,96; р для тенденции =0,01). Назначение антиагрегантов было независимым фактором риска развития осложнений в периоперационном периоде (ОШ=0,18, 95% ДИ от 0,05 до 0,69). Выводы. В настоящем исследовании продемонстрировали, что у пациентов с симптомным стенозом сонной артерии проведенное лечение статинами оказывает дозозависимое влияние на снижение риска развития осложнений в периоперационном периоде.

Литература


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