急性心肌梗死患者出院时未行最佳药物治疗的影响因素

Influencing factors of insufficient optimal medical therapy for patients with acute myocardial infarction at discharge

目的探讨急性心肌梗死患者出院时未行最佳药物治疗的影响因素。方法选取2019年1月至2019年12月在河北北方学院附属第一医院诊治的急性心肌梗死患者368例。按出院时是否开具至少一种抗栓药、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)、β受体阻滞剂及他汀类药物,将研究对象分为最佳药物治疗(OMT)组245例及非最佳药物治疗(non-OMT)组123例。收集研究对象的临床基本资料、实验室结果及冠状动脉病变结果,分析急性心肌梗死患者出院时未行OMT的影响因素。结果两组相比,年龄、性别、慢性阻塞性肺病(COPD)病史、急性心肌梗死类型、心率、肌钙蛋白峰值、左心室射血分数及此次入院是否行经皮冠状动脉介入术(PCI)差异有统计学意义(t/χ^(2)=4.247、20.593、11.060、12.512、2.040、2.043、2.217、26.020,P<0.05)。多因素Logistic回归分析结果显示,性别、年龄、COPD病史、急性心肌梗死类型和此次入院是否行PCI是non-OMT的影响因素[OR(95%CI)=2.220(1.357~3.631)、1.060(1.023~1.099)、3.782(1.213~11.788)、2.365(1.439~3.889)、0.271(0.143~0.513),P<0.05]。结论年龄、女性、COPD病史、急性心肌梗死类型及此次入院未行PCI是急性心肌梗死患者出院时未行OMT的影响因素。

Objective To investigate the influencing factors of insufficient optimal medical therapy(OMT)for patients with acute myocardial infarction(AMI)at discharge.Methods 368 patients with AMI treated in the first affiliated hospital of Hebei north university from 2019 January to 2019 December were enrolled,who were divided into OMT group(n=245)and non-OMT group(n=123)according to the prescription at discharge whether including at least one kind of antithrombotic drugs,angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB),beta blockers and statins.The Clinical data,laboratory results and coronary artery lesions were collected to analyze the influencing factors of insufficient optimal medical therapy.Results There were statistically significant differences between the two groups in age,gender,history of chronic obstructive pulmonary disease(COPD),type of AMI,heart rate,peak value of troponin I,left ventricular ejection fraction(LVEF)and whether percutaneous coronary intervention(PCI)was performed at admission(t/χ^(2)=4.247,20.593,11.060,12.512,2.040,2.043,2.217,26.020,P<0.05).Multiple logistic regression analysis showed that gender,age,COPD history,type of AMI and PCI was performed on admission were influencing factors of non-OMT[OR(95%CI)=2.220(1.357-3.631),1.060(1.023-1.099),3.782(1.213-11.788),2.365(1.439-3.889),0.271(0.143-0.513),P<0.05].Conclusion Age,female,history of COPD,type of AMI and the absence of PCI performed on admission are the influencing factors of insufficient OMT for patients with AMI at discharge.