Marinigh Ricarda, Fioretti Paolo M, Pecoraro Rosa, Fresco Claudio, Brusaferro Silvio
Department of Cardiopulmonary Sciences, Azienda Ospedaliero-Universitaria di Udine, Italy.
Monaldi Arch Chest Dis. 2007 Mar;68(1):31-5. doi: 10.4081/monaldi.2007.466.
Percutaneous coronary intervention (PCI) is the most frequently used revascularization approach, often repeatedly applied. The quest for the ultimate revascularization procedure however may capture cardiologist's attention and lead them to minimize the issue of secondary prevention in their patients. Aims of this study were to assess: 1. The individual risk factor profile, 2. The relation between the risk factors correction and the number of hospital admissions for elective procedures, 3. The appropriateness of medical treatment in patients admitted for elective coronary invasive procedures (diagnostic and interventional). 4. The patients knowledge of threshold values for cardiovascular risk factors.
100 patients (71% males, mean age 68 years) consecutively admitted for elective coronary angiography or PCI. They underwent a classical risk factors assessment and were divided in three groups according to the number of admissions for coronary angiography and in two groups according to the number of PCIs.
Fifty-seven% of patients had been previously admitted for invasive examination at least three times and 58% had already been treated with at least one PCI. Seventy-one% were treated with beta-blockers but only 25% of them received a dosage found effective in RCTs (randomized clinical trials). Sixty% were treated with ACE-inhibitors and 83% received the dosage found effective in RCTs. Fifty-two% were treated with statins and 95% received a dosage found effective in RCTs. Nine% were still active smokers. Fourty-nine% had a LDL cholesterol level above 100 mg/dL. The percentage of patients not on target was unrelated to the number of hospital admissions for invasive procedures.
Modern cardiology is quickly embracing high tech procedures and trials results but often fails to spend enough time teaching how to control risk factors according to the recommendations of the evidence-based guidelines, even independently of the number of hospitalizations for invasive cardiovascular procedures.
经皮冠状动脉介入治疗（PCI）是最常用的血运重建方法，常被反复应用。然而，对终极血运重建程序的追求可能会吸引心脏病专家的注意力，并导致他们忽视患者二级预防的问题。本研究的目的是评估：1. 个体危险因素概况；2. 危险因素校正与择期手术住院次数之间的关系；3. 因择期冠状动脉介入手术（诊断性和介入性）入院患者的药物治疗合理性；4. 患者对心血管危险因素阈值的了解情况。
100例连续因择期冠状动脉造影或PCI入院的患者。他们接受了经典的危险因素评估，并根据冠状动脉造影的住院次数分为三组，根据PCI的次数分为两组。
57%的患者此前至少因侵入性检查入院三次，58%的患者已接受至少一次PCI治疗。71%的患者接受了β受体阻滞剂治疗，但其中只有25%的患者接受了在随机临床试验（RCT）中被证明有效的剂量。60%的患者接受了血管紧张素转换酶抑制剂（ACEI）治疗，83%的患者接受了在RCT中被证明有效的剂量。52%的患者接受了他汀类药物治疗，95%的患者接受了在RCT中被证明有效的剂量。9%的患者仍在积极吸烟。49%的患者低密度脂蛋白胆固醇水平高于100mg/dL。未达标的患者百分比与侵入性手术的住院次数无关。
现代心脏病学迅速采用高科技手术和试验结果，但往往没有花足够的时间教授如何根据循证指南的建议控制危险因素，即使与侵入性心血管手术的住院次数无关。
