冠状动脉搭桥术后功能测试结果对抗心绞痛药物处方模式的影响：ROSETTA-CABG注册研究结果

Impact of functional testing results on prescription patterns of anti-anginal medication after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.

作者信息

Wou Karen, Nguyen Hiep, Duerr Robert, Del Core Michael, Fourchy Dominique, Huynh Thao, Lader Ellis, Rogers Felix J, Chaudhry Rashid, Pilote Louise, Eisenberg Mark J

机构信息

Jewish General Hospital-McGill University, Center for Epidemiology and Community Studies, Suite A-118, 3755 Cote Ste. Catherine, Montreal, Quebec, Canada, H3T 1E2.

出版信息

J Invasive Cardiol. 2006 Jun;18(6):278-82.

PMID:16751682

Abstract

BACKGROUND

Although coronary artery bypass graft surgery (CABG) is known to reduce angina, previous studies have suggested that anti-anginal medication use is not significantly reduced after CABG. However, it is unclear how functional testing results have an impact on anti-anginal medication prescription patterns.

OBJECTIVES

To determine whether post-CABG functional testing results impact prescription patterns of anti-anginal medication during the 12 months after CABG.

METHODS

The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter study. We examined anti-anginal medication use (beta blockers, calcium channel blockers and nitrates) at discharge and at 12 months post-CABG with respect to functional testing results among 392 patients.

RESULTS

Among the 392 patients, 146 had at least one functional test over the 12-month follow up period. Among the 146 patients, 17% had positive functional tests, 69% had negative tests, and 14% had indeterminate tests. Both beta blocker and calcium channel blocker use did not increase from discharge to 12 months following a positive test (N = 25) (84% vs. 80%; p = NS; 16% vs. 16%; p = NS), while nitrate use increased seven-fold (4% vs. 28%; p = 0.03). However, following a negative test (N = 100), beta blocker use only decreased modestly (85% vs. 70%; p = 0.01), while both calcium channel blocker and nitrate use were unchanged (30% vs. 20%; p = NS; 4% vs. 6%; p = NS, respectively). Following an indeterminate test (N = 21), anti-anginal medication use was unchanged (p = NS for all 3 classes of medication).

CONCLUSION

The use of anti-anginal medication is only modestly reduced after CABG, and functional testing results during the first year post-CABG do not have a strong impact on prescription patterns of anti-anginal agents.

摘要

背景

尽管冠状动脉旁路移植术（CABG）已知可减轻心绞痛，但先前的研究表明，CABG术后抗心绞痛药物的使用并未显著减少。然而，尚不清楚功能测试结果如何影响抗心绞痛药物的处方模式。

目的

确定CABG术后功能测试结果是否会影响CABG术后12个月内抗心绞痛药物的处方模式。

方法

冠状动脉旁路移植术后常规与选择性运动平板试验（ROSETTA-CABG）注册研究是一项前瞻性多中心研究。我们在392例患者中，根据功能测试结果，检查了CABG出院时和术后12个月时抗心绞痛药物（β受体阻滞剂、钙通道阻滞剂和硝酸盐）的使用情况。

结果

在392例患者中，146例在12个月的随访期内至少进行了一次功能测试。在这146例患者中，17%的功能测试结果为阳性，69%为阴性，14%为不确定。功能测试结果为阳性（N = 25）的患者从出院到术后12个月，β受体阻滞剂和钙通道阻滞剂的使用均未增加（84%对80%；p = 无显著性差异；16%对16%；p = 无显著性差异），而硝酸盐的使用增加了7倍（4%对28%；p = 0.03）。然而，功能测试结果为阴性（N = 100）的患者，β受体阻滞剂的使用仅略有下降（85%对70%；p = 0.01），而钙通道阻滞剂和硝酸盐的使用均未改变（分别为30%对20%；p = 无显著性差异；4%对6%；p = 无显著性差异）。功能测试结果为不确定（N = 21）的患者，抗心绞痛药物的使用未发生变化（所有3类药物的p值均为无显著性差异）。