冠状动脉搭桥手术后使用二级预防药物的相关结果。
Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery.
作者信息
Goyal Abhinav, Alexander John H, Hafley Gail E, Graham Stacy H, Mehta Rajendra H, Mack Michael J, Wolf Randall K, Cohn Lawrence H, Kouchoukos Nicholas T, Harrington Robert A, Gennevois Daniel, Gibson C Michael, Califf Robert M, Ferguson T Bruce, Peterson Eric D
机构信息
Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
出版信息
Ann Thorac Surg. 2007 Mar;83(3):993-1001. doi: 10.1016/j.athoracsur.2006.10.046.
BACKGROUND
Secondary prevention medications are beneficial after acute coronary syndromes, but these benefits are less clear after coronary artery bypass graft surgery. We investigated whether greater use of secondary prevention medications after coronary artery bypass graft surgery is associated with improved clinical outcomes.
METHODS
Patients undergoing coronary artery bypass graft surgery in the PREVENT IV trial (n = 2970) were surveyed for use of antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents after hospital discharge and at 1 year. Patients were categorized based on their percentage use of indicated medications after hospital discharge. Cox modeling was used to determine the association between medication use categories and rates of death or myocardial infarction through 2 years after adjustment for clinical factors, the number of indicated medications, and treatment propensity.
RESULTS
Rates of use of antiplatelet agents and lipid-lowering agents were high at discharge and at 1 year, but use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was suboptimal. There was a stepwise association between medication use at discharge and patient outcomes (p for trend = 0.014). Patients taking 50% or less of indicated medications at discharge had a significantly higher 2-year rate of death or myocardial infarction (8.0% versus 4.2%; adjusted hazard ratio, 1.69; 95% confidence interval, 1.12 to 2.55; p = 0.013) than those taking all indicated medications.
CONCLUSIONS
Greater use of indicated secondary prevention medications after coronary artery bypass graft surgery is associated with a lower 2-year rate of death or myocardial infarction. These data underscore the importance of appropriate secondary prevention measures to improve long-term clinical outcomes after coronary artery bypass graft surgery.
背景
二级预防药物在急性冠脉综合征后有益，但在冠状动脉旁路移植术后这些益处尚不太明确。我们调查了冠状动脉旁路移植术后更多使用二级预防药物是否与改善临床结局相关。
方法
对PREVENT IV试验中接受冠状动脉旁路移植术的患者（n = 2970）出院时及1年后使用抗血小板药物、β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂以及降脂药物的情况进行调查。根据出院后使用指定药物的百分比对患者进行分类。采用Cox模型来确定在调整临床因素、指定药物数量和治疗倾向后，药物使用类别与2年内死亡或心肌梗死发生率之间的关联。
结果
出院时及1年时抗血小板药物和降脂药物的使用率较高，但β受体阻滞剂以及血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的使用未达最佳。出院时药物使用情况与患者结局之间存在逐步关联（趋势p值 = 0.014）。出院时服用指定药物50%或更少的患者2年死亡或心肌梗死发生率显著高于服用所有指定药物的患者（8.0%对4.2%；调整后风险比为1.69；95%置信区间为1.12至2.55；p = 0.013）。
结论
冠状动脉旁路移植术后更多使用指定的二级预防药物与较低的2年死亡或心肌梗死发生率相关。这些数据强调了适当的二级预防措施对改善冠状动脉旁路移植术后长期临床结局的重要性。
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