急性冠状动脉综合征患者院外服用替格瑞洛现状调查分析

Contemporary use of ticagrelor in patients with acute coronary syndrome after discharge

目的了解急性冠状动脉综合征（ACS）患者出院后替格瑞洛的服用现状，并分析提前停服替格瑞洛的影响因素。方法收集阜外医院冠心病中心2015年1至6月收治的出院服用替格瑞洛的ACS患者，采用病历查阅和电话或门诊随访方式收集资料，对患者院外替格瑞洛服用情况进行统计分析。结果本研究共纳入404例患者，158例（39．1％）1年内提前停服替格瑞洛，其中119例更换为氯吡格雷（29．5％）。提前停服原因构成比中以药物可及性（34．8％）、经济原因（17．7％）、出血事件（18．4％）为主。单因素统计分析结果显示病变类型（P=0．04）、门诊复诊频次（P〈0．01）与提前停服替格瑞洛相关；多因素统计结果显示医保结算（OR1．79，95％CI1．03-3．11）和我院门诊复诊频次（OR0．61，95％CI0．43-0．86）是提前停服替格瑞洛的独立影响因素。提前停服替格瑞洛对于缺血事件的发生没有显著影响（P=0．76）。结论社会学原因是影响患者替格瑞洛使用持续性的主要因素，医保结算、复诊频次低是提前停服替格瑞洛的独立危险因素，但提前停服替格瑞洛并不增加缺血事件的发生。

Objective To investigate the degree and determinants of using ticagrelor among discharged patients with acute coronary syndrome （ACS）. Methods Patients with ACS in Fuwai hospital who were given ticagrelor after discharge between Jan. 2015 to Jun. 2015 were analyzed. The clinical characteristics and adherence to ticagrelor of these patients were collected by reviewing the electronic medical records and telephone interview. Date were statistically-analyzed. Results Among all screened 404 patients, 158 （39. 1%） patients prematurely stopped ticagrelor within 12 months, while 119 （29.5%） patients switched from ticagrelor to clopidogrel. Unavailable locally （ 34. 8% ）, economic reasons （ 17. 7% ） and hemorrhagic events （18.4%） were the main causes of the premature discontinuation of ticagrelor. Univariate analysis showed left main disease （ P = 0.04） and the frequency of outpatient follow-up （ P 〈 0. 01 ） as relative factors for prematurely stopping ticagrelor outside hospital after discharge. Multivariate analysis revealed medical insurance payment （ OR 1.79,95% CI 1.03 - 3.11 ） and the frequency of outpatient follow- up （ OR 0. 61,95% CI 0. 43 - 0. 86） as independent predictors of prematurely stopping ticagrelor outside hospital. Prematurely stopping ticagrelor has no significant effect on the ischemic events （ myocardial infaction or stroke） （P = 0. 76）. Conclusion Social cinditions is the main factor for the persistence to ticagrelor among ACS patients after dischcrge. Medical insurance payment and low frequency of outpatient follow-up were independent predictors of prematurely stopping ticagrelor and it may not have impact on ischemic events.