Goldberg Robert J, Spencer Frederick A, Steg Philippe Gabriel, Flather Marcus, Montalescot Gilles, Gurfinkel Enrique P, Kennelly Brian M, Goodman Shaun G, Dedrick Rebecca, Gore Joel M
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave, Worcester, MA 01655, USA.
Arch Intern Med. 2007 Sep 10;167(16):1766-73. doi: 10.1001/archinte.167.16.1766.
Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI).
We explored a recent 5-year (2000-2005) trend in hospital use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and combinations thereof, in 26 413 adult men and women without contraindications to any of these therapies discharged after AMI from hospitals located in 14 countries that were included in the Global Registry of Acute Coronary Events.
Relatively steady increases in the use of ACE inhibitors, beta-blockers, and statin therapy were observed over time, with particularly marked increases in the use of lipid-lowering therapy (from 45% in 2000 to 85% in 2005). Aspirin use remained high (by approximately 95% of patients after AMI) during all periods examined. The percentage of hospital survivors treated with all 4 cardiac medications increased from 23% in 2000 to 58% during 2005. Advancing age (>/= 65 years), female sex, medical history of heart failure or stroke, and development of atrial fibrillation during hospitalization were associated with underuse of combination medical therapy. Relatively similar factors were associated with the underuse of combination medical therapy in patients with ST-segment elevation AMI and non-ST-segment elevation AMI.
Our results suggest encouraging increases over time in the use of combination medical therapy in patients hospitalized with AMI without contraindications to these medications. Educational efforts designed to increase the use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.
当前的实践指南建议在急性心肌梗死（AMI）住院幸存者中常规使用几种有效的心脏药物。
我们探讨了近期（2000 - 2005年）在全球急性冠状动脉事件注册研究纳入的14个国家的医院中，26413例无这些治疗禁忌证的成年男性和女性AMI出院后，阿司匹林、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、降脂药物及其联合用药的医院使用趋势。
随着时间的推移，观察到ACE抑制剂、β受体阻滞剂和他汀类药物治疗的使用相对稳定增加，降脂治疗的使用增加尤为显著（从2000年的45%增至2005年的85%）。在所有检查期间，阿司匹林的使用率均保持在较高水平（AMI后约95%的患者使用）。接受全部4种心脏药物治疗的住院幸存者比例从2000年的23%增至2005年的58%。年龄增长（≥65岁）、女性、有心力衰竭或中风病史以及住院期间发生房颤与联合药物治疗使用不足相关。ST段抬高型AMI和非ST段抬高型AMI患者联合药物治疗使用不足与相对相似的因素相关。
我们的结果表明，在无这些药物禁忌证的AMI住院患者中，联合药物治疗的使用随时间推移有令人鼓舞的增加。旨在增加这些治疗方法使用的教育努力，以及简化药物治疗方案和提高依从率的努力，仍然是必要的。
