经皮冠状动脉介入术后优化药物治疗应用现状及其对预后的影响

The application status of optimal medical therapy after percutaneous coronary intervention and its influence on prognosis

目的研究经皮冠状动脉介入术(PCI)后冠心病患者优化药物治疗(OMT)的应用现状及其对术后患者1年预后的影响。方法前瞻性收集2016年10月至2017年9月在泰达国际心血管病医院心内科通过冠状动脉造影确诊为冠心病并成功完成PCI的3812例患者资料,记录患者的院内及其出院后1、6、12个月的OMT使用情况及主要不良心脑血管事件(MACCE)发生情况。根据患者PCI术后是否坚持OMT分为OMT组(n=1299)和非OMT组(n=2289)。应用χ2检验比较组间MACCE的差异,筛选组间差异有统计学意义及有临床意义的变量,应用Cox回归模型分析影响PCI术后MACCE发生的影响因素。结果3588例(224例失访)PCI术后患者住院期间OMT应用比例为58.8%(2110/3588),随访12个月坚持OMT的患者有36.0%(1293/3588)。OMT各组分药物的应用比例均呈下降趋势,其中随访12个月时,β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)的下降程度最大,分别从75.3%(2701/3588)和75.1%(2692/3588)降至59.1%(2122/3588)和53.0%(1903/3588)。应用Pearsonχ2分析发现老年患者、合并疾病的数量、PCI病史、陈旧性心肌梗死病史、慢性肾功能不全病史、病变支数、病变类型、Gensini评分、随访期间坚持OMT和吸烟的情况与PCI术后MACCE发生相关,差异有统计学意义(均P<0.05)。Cox回归模型显示PCI术后坚持OMT是患者术后发生MACCE事件的独立保护因素(HR=0.471,95%CI:0.300~0.734,P=0.001)。结论PCI术后OMT应用非最优,应用比例随着出院时间的延长而降低,其中ACEI/ARB、β受体阻滞剂的使用需要值得更加关注。PCI术后坚持OMT是独立的保护性因素,可以降低患者术后MACCE的发生率,改善患者预后。

Objective To investigate the application status of optimal medical therapy(OMT)in patients with coronary heart disease after percutaneous coronary intervention(PCI)and its influence on the 1-year prognosis of patients after surgery.Methods Data of 3812 patients diagnosed with coronary heart disease by coronary angiography and successfully completed PCI in the Department of Cardiology,TEDA International Cardiovascular Hospital from October 2016 to September 2017 were prospectively collected.The OMT status and the occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)during the hospitalization and 1,6,and 12 months after discharge were recorded.Patients were divided into OMT group(n=1299)and non-OMT group(n=2289)according to their adherence to OMT after PCI.Chi-square test was used to compare the differences of MACCE between groups,and to screen for significant differences and clinically significant variables between groups.Cox regression model was used to analyze the influencing factors of MACCE after PCI.Results Among 3588 patients(224 cases lost to follow-up),58.8%(2110/3588)used OMT during hospitalization after PCI,and 36.0%(1293/3588)still adhered to OMT after 12 months of follow-up.The utilization rates of OMT showed a decreasing trend,among which till the 12th month,β-blockers and ACEI/ARB showed the greatest decreasing degree,from 75.3%(2701/3588)and 75.1%(2692/3588)to 59.1%(2122/3588)and 53.0%(1903/3588).Pearsonχ2 analysis showed that elderly patients,the number of amalgamative diseases,history of PCI,history of chronic myocardial infarction,history of chronic renal insufficiency,the lesion counts,lesion type,the Gensini score,adhere to the OMT and smoking during the follow-up were related to postoperative MACCE,the difference was statistically significant(P<0.05).Cox regression model showed that OMT adherence after PCI was an independent protective factor for postoperative MACCE events(HR=0.471,95%CI:0.300-0.734,P=0.001).Conclusion The application of OMT after PCI was suboptimal,and the application rate decreased with the lengthening of the discharge time,among which the use of ACEI/ARB andβ-blockers deserved more attention.Adherence to OMT after PCI was an independent protective factor,which could reduce the incidence of postoperative MACCE and improve the prognosis of patients.