急性冠脉综合征患者二级预防用药现状调查与规范化治疗随访研究

Comparison of standard secondary prevention and regular secondary prevention of ACS(acute coronary syndrome) patients: 12-month follow-up result

目的了解急性冠脉综合征患者二级预防药物使用状况;比较急性冠脉综合征患者出院一年内规范化二级预防用药和常规用药依从性、生化指标、血压,评定规范化用药与常规用药患者预后结果及主要事件的关系。方法急性冠脉综合征住院患者251例,随机分为规范化组(A组)和常规组(B组),以调查问卷为工具,A组依照指南要求强化详细的药物指导和生活方式干预措施进行危险因素控制,B组进行常规随访,期间不予以特殊干预。比较两组患者出院一年后门诊复查生化指标检查、血压、MACE事件、药物依从性上的差异。结果两组在基线水平上无明显的差异。随访一年后,A组患者药物依从性较好(阿司匹林100.0%,他汀100.0%,β-blocker 98.9%,ACEI/ARB 98.9%),而B组相对较差(阿司匹林99.2%,他汀78.6%,β-blocker 60.2%,ACEI/ARB 58.0%),两组患者的他汀、β-blocker、ACEI/ARB三类药物依从性存在显著的统计学差异;血压不具有统计学差异;A组的总胆固醇和低密度脂蛋白较B组低,甘油三酯、高密度脂蛋白和血糖未显示出明显差异;在主要终点心脏不良事件(MACE)上,A组MACE事件发生率较B组低,具有统计学差异。结论目前我国二级预防用药存在明显差异性,经过强化规范化治疗对出院的急性冠脉综合征患者可以明显减低心脏不良事件的发生率。

Objective To investigate the consumption of secondary prevention drugs in acute coronary syndrome patients; To compare drug adherence, blood pressure, and biochemical indicators between standard secondary prevention and regular secondary prevention of ACS patients discharged from hospital so as to assess the relationship between standardized treatment with conventional treatment prognosis of patients and major events. Methods A total enrollment of 251 hospitalized patients with ACS were randomly assigned to 2 groups：standardization group （Group A） and conventional group （Group B） . Questionnalre is the research tool. Group A are required to strengthen the detalled guidance and lifestyle interventions in accordance with the guidelines for risk factor control, and Group B were not given special intervention. Then after 12-month follow-up, we contrast the differences between these 2 groups discharged from hospital in the biochemical indicators, blood pressure, MACE, and drug adherence. Results There was no significant difference in baseline levels. After 12-month follow-up, Group A has better drug adherence （aspirin 100%,statins 100%,β-blocker 98.9%,ACEI/ARB 98.9%） than Group B （aspirin 99.2%,statins 78.6%,β-blocker 60.2%,ACEI/ARB 58.0%）. There was significant statistical difference in stalns,β-blocker, drug adherence of ACEI/ARB, but there was no statistical difference in blood pressure. Group A has a lower cholesterol and LDL than Group B, and there was no significant difference in TG, HDL, and plasma glucose;Group A has lower MACE than group B, have statistical difference. Conclusion There exists significant differences in secondary prevention medication in China. The strengthened standardized treatment for ACS patient discharged from hospital can significantly reduce the incidence of cardiac adverse events.