Mehta Rajendra H, Bhatt Deepak L, Steg Ph Gabriel, Goto Shinya, Hirsch Alan T, Liau Chiau-Suong, Röther Joachim, Wilson Peter W F, Richard Alain-Jean, Eagle Kim A, Ohman E Magnus
Duke Clinical Research Institute, 2400 Pratt Street, PO Box 17969, Durham, NC, USA.
Eur Heart J. 2008 Dec;29(24):3052-60. doi: 10.1093/eurheartj/ehn478. Epub 2008 Nov 7.
To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG).
Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25-<50, 50-<75, and > or =75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25-<50, 50-<75, and >75% risk factors at goal, respectively; P for trend 0.059).
Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health.
评估实现心血管（CV）危险因素的二级预防目标治疗对既往接受冠状动脉旁路移植术（CABG）患者临床结局的影响。
因此，我们分析了全球持续健康动脉粥样硬化血栓形成减少（REACH）注册研究中既往接受CABG且患有动脉粥样硬化血栓形成疾病或已知危险因素（糖尿病、高血压、高胆固醇血症、吸烟、肥胖）患者的达标治疗情况，以及它们与1年结局的关联。REACH研究中68236例患者中有13907例（20.4%）有既往CABG病史，其中13207例有1年结局数据。在基线时，分别有3.7%、12.9%、31.7%和51.7%的患者的<25%、25% - <50%、50% - <75%和≥75%的危险因素达标。CV死亡、非致死性心肌梗死、非致死性卒中的1年复合发生率与基线时达标危险因素的比例呈负相关（年龄、性别和地区校正率分别为<25%、25% - <50%、50% - <75%和>75%危险因素达标的患者的6.1%、5.6%、5.2%和4.3%；趋势P值为0.059）。
CABG患者的危险因素控制差异很大。尽管CABG患者经常接受适当的治疗，但这些治疗在许多患者中未能达到足够的预防水平。这种未达标与年龄、性别和地区校正后的临床结局较差的趋势相关。因此，或许CABG后的二级预防需要更全面地针对目标对危险因素进行调整，以期预防后续CV事件，这是改善CV健康的一个机会。
