Steinberg Benjamin A, Steg P Gabriel, Bhatt Deepak L, Fonarow Gregg C, Zeymer Uwe, Cannon Christopher P
Thrombolysis In Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Am J Cardiol. 2007 May 1;99(9):1212-5. doi: 10.1016/j.amjcard.2006.12.039. Epub 2007 Mar 16.
To evaluate current compliance with recommendations for medical therapy in patients with coronary artery disease (CAD), the relation between previous revascularization and use of guideline-recommended therapies was investigated. From 5,400 outpatient practices in 44 countries, we compared baseline characteristics and medical therapy of 40,450 patients with documented CAD (all with previous myocardial infarction, percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or angina pectoris) by previous revascularization status. Approximately 33% of patients had previous CABG, 33% had previous PCI, and 33% had no previous revascularization. Patients with previous CABG were older and often men and diabetic. Patients with previous PCI were the youngest. Guideline-recommended medical therapy use was significantly higher in those with previous revascularization. Antiplatelet therapy in medically managed patients was 80% versus 86% and 91% for those with previous CABG or PCI, respectively. Use of any lipid-lowering agent in those with previous CABG or PCI was 86% in the 2 groups versus 70% in patients who were medically managed. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were used in similar ratios among groups. Previous revascularization appears to be associated with better use of guideline-recommended medical treatment. These trends were similar for patients from the United States versus everywhere else. In conclusion, use of evidence-based, guideline-recommended therapies in outpatients with CAD needs to improve, especially in medically managed patients.
为评估冠心病（CAD）患者目前对药物治疗推荐的依从性，我们研究了既往血运重建与指南推荐治疗方法使用之间的关系。我们从44个国家的5400个门诊机构中，根据既往血运重建状态，比较了40450例确诊为CAD（均有既往心肌梗死、经皮冠状动脉介入治疗[PCI]、冠状动脉旁路移植术[CABG]或心绞痛）患者的基线特征和药物治疗情况。约33%的患者曾接受过CABG，33%的患者曾接受过PCI，33%的患者既往未接受过血运重建。既往接受过CABG的患者年龄较大，多为男性且患有糖尿病。既往接受过PCI的患者最年轻。既往接受过血运重建的患者对指南推荐的药物治疗的使用率显著更高。药物治疗患者的抗血小板治疗使用率为80%，而既往接受过CABG或PCI的患者分别为86%和91%。既往接受过CABG或PCI的两组患者中，使用任何降脂药物的比例为86%，而药物治疗患者为70%。各组中血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的使用比例相似。既往血运重建似乎与更好地使用指南推荐的药物治疗相关。美国患者与其他地区患者的这些趋势相似。总之，CAD门诊患者对循证、指南推荐治疗方法的使用需要改善，尤其是在药物治疗患者中。
