冠心病患者经皮冠状动脉介入治疗术后药物治疗现状及其与长期预后的关系

The Medical Treatment After Percutaneous Coronary Intervention and Its Relationship to Long-Term Outcomes:A Single Centre Experience

目的:调查冠心病患者经皮冠状动脉介入治疗(PCI)术后应用药物及其与长期预后的关系。方法:对584例冠心病患者PCI术后应用的主要药物及吸烟状况进行调查,并对主要心脏不良事件进行随访。结果:平均随访时间(18.66±12.16)个月,术后99.0%的患者应用阿司匹林,应用时间平均(10.3±8.2)个月,99.8%使用氯吡格雷,应用时间平均(7.8±5.0)个月;随访期间5.14%患者完全停止抗血小板治疗。在出院时,血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、他汀类药物、钙通道拮抗剂及硝酸酯的应用率分别为42.0%、63.7%、83.0%、19.9%及46.4%,随访期间降低到36.1%、57.0%、66.8%、17.6%及36.6%。术前吸烟为53.77%,随访期间为17.80%。停止抗血小板治疗、术后吸烟增加非致死性心肌梗死(10.0%对1.1%,P<0.01;4.81%对0.83%,P<0.01)及主要不良心脏时间(20.0%对6.9%,P<0.01;11.54%对6.67%,P<0.05)。结论:冠心病患者在PCI术后对药物的依从性良好,但术后停止抗血小板治疗及继续吸烟者预后差。

To investigate the medical treatment in the patients undergoing percutaneous coronary intervention （PCI） in real world and its relationship to the long-term outcomes. Methods： The survey was performed in 584 patients undergoing PCI in our department. Major adverse cardiac events （MACE） and the usage of antiplatelet agents, angiotensin converting enzyme inhibitor （ACEl）/angiotensin Ⅱ receptor blocker （ARB）, statins, beta blocker, calcium channel blocker（CCB） and nitrates at discharge and follow-up were carefully recorded. Results ： The average follow-up time was 18. 66±12.16 months. At discharge, 578 patients （99.0%） were on aspirin therapy, 583 patients （99. 8% ） were given clopidogrel with average duration of 7.8±5.0 months, There were 30 patients who completely discontinued antiplatelet therapy during follow-up. At discharge, the prescription rate of ACEI/ARB, beta blocker, statins, CCB and nitrates was 42.0%, 63.7% ,83.0% ,19. 9% and 46.4%, 36.1%, 57. 0%, 66. 8%, 17.6% and 36, 6% at follow-up. At follow-up, there were 104 current smokers （ 18.25% ）, Complete cessation of antiplatelet therapy and current smoking were related to the increased risk of non-fatal MI（ 10. 0% vs 1.08% ,P 〈0. 01 ;smoking 4. 81% vs 0. 83%, P 〈0.01 ） and MACE（20. 0% vs 6. 86% ,P 〈0. 01 ;smoking 11.54% vs 6.67% ,P 〈0. 05）. Conclusions： Most patients adhered to the medical treatment during follow-up, however, complete cessation of antiplatelet therapy and current smoking increased the risk for non-fatal MI and MACE.