疑诊冠状动脉性心脏病患者冠状动脉CT检查后吸烟及用药情况的改变

Changes in Smoking and Medication after Coronary CT Angiography in Patients with Suspected Coronary Heart Disease

目的探讨疑诊冠状动脉性心脏病(简称"冠心病")患者行冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)检查对其吸烟和主要用药情况的影响。方法纳入2017年2月至2018年7月门诊疑诊冠心病行CCTA检查并完成随访的连续患者2077例,记录患者检查前后吸烟状态以及抗血小板药物、降脂药物的服用情况,按照CT提示有无≥50%狭窄,分为冠心病组和无冠心病组,比较CCTA检查后2组间吸烟情况与服用抗血小板药物和降脂药物情况的变化。结果患者平均年龄(57.12±10.39)岁,男性占68.1%。CT结果提示无冠心病组1555例,冠心病组522例,平均随访391(143~693)d,98例患者出现主要不良心血管事件(major adverse cardiovascular events,MACE),包含71例血运重建。CCTA检查后,吸烟人数总体减少325例(32.24%)。冠心病组抗血小板药物及降脂药物的服用人数分别增加5例(2.27%)、33例(20.00%),无冠心病组两种药物的服用人数分别减少158例(41.15%)、84例(27.10%)。冠心病组检查后戒烟率(检查前吸烟,检查后不吸烟)较无冠心病组高(24.33%:13.76%,P<0.001)。冠心病组新增抗血小板与降脂药物服用(检查前不服用药物,检查后服用)均较无冠心病组高(22.03%:5.92%,23.37%:7.14%,P<0.001)。多因素logistic回归分析显示CCTA结果(冠心病)与戒烟(OR:1.458,95%CI:1.108~1.918)、新增服用抗血小板药物(OR:5.082,95%CI:3.617~7.141)及新增服用降脂药物(OR:3.997,95%CI:2.906~5.496)相关(P<0.001),且是新增服用抗血小板药物的独立相关因素。结论CCTA检查结果提示冠心病,可提高戒烟率,增加抗血小板与降脂药物的使用;相反,CCTA结果显示无冠心病,可减少抗血小板与降脂药物的使用。CCTA检查可促进疑诊冠心病患者向更积极健康的生活方式改变,且更合理地使用心血管病预防药物。

Objective To determine the influence of coronary computed tomographic angiography(CCTA)on the changes of smoking,antiplatelet and lipid-lowering medication use in patients with suspected coronary heart disease.Methods A total of 2077 consecutive outpatients suspected with coronary heart disease were enrolled from February 2017 to July 2018.They all had undergone CCTA examinations and completed the follow-up data after CCTA examination.The smoking status、antiplatelet and lipid-lowering medication use were recorded pre-and post-CCTA.According to the CT indication of≥50%stenosis,patients were divided into two groups:"coronary artery disease group(CAD)"and"non-coronary artery disease group(non-CAD)",and the changes in smoking status,antiplatelet and lipid-lowering drug use between the two groups were compared.Results The mean age of these patients was(57.12±10.39)years old(68.1%men).CT results showed that there were 1555 cases in the non-CAD group and 522 cases in the CAD group.Major adverse cardiovascular events(MACE)occurred in 98 patients in the follow-up of 391 days(range 143-693),including 71 cases of revascularization.After CCTA examination,the number of smokers decreased by 325(32.24%),the number of antiplatelet and lipid-lowering drugs increased by 5(2.27%)and 33(20.00%)respectively in the CAD group while decreased by 158(41.15%)and 84(27.10%)respectively in the non-CAD group.The smoking cessation rate in the CAD group was higher than that in the non-CAD group after examination(24.33%vs 13.76%,P<0.01).The initiation of antiplatelet and lipid-lowering drugs in CAD group was higher than that in non-CAD group(22.03%vs 5.92,23.37%vs 7.14%,P<0.01).Multivariate logistic regression analysis showed that CCTA results-identified CAD were correlated with smoking cessation,initiation of antiplatelet lipidlowering drugs(OR:1.458,95%CI:1.108-1.918;OR:5.082,95%CI:3.617-7.141;OR:3.997,95%CI:2.906-5.496,all P<0.01),and was an independent correlation factor for the initiation of antiplatelet drugs.Conclusion CAD presence on CCTA is associated with increased smoking cessation rate and initiation of preventive cardiovascular medications use.On the contrary,non-CAD presence on CTA can reduce the use of antiplatelet and lipid-lowering drugs.CCTA can promote patients suspected of coronary heart disease to a healthier lifestyle,and more appropriate allocation of preventive cardiovascular disease medications.