Maddox Thomas M, Ho P Michael, Roe Matthew, Dai David, Tsai Thomas T, Rumsfeld John S
Denver VAMC/University of Colorado Denver, USA.
Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):632-41. doi: 10.1161/CIRCOUTCOMES.109.906214. Epub 2010 Oct 5.
Secondary prevention therapies are indicated for patients with coronary artery disease (CAD). However, patients with nonobstructive CAD may be less likely to receive these therapies compared with patients with obstructive CAD. Therefore, we compared rates of secondary prevention medication prescription between patients with nonobstructive and obstructive CAD.
We conducted a retrospective cohort study of 1 489 745 CAD patients undergoing cardiac catheterization in 786 US centers between 2004 and 2007. We measured rates of aspirin, statin, β-blocker, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) prescription at hospital discharge among eligible patients; 237 167 (15.9%) patients had nonobstructive CAD and 1 252 578 (84.1%) had obstructive CAD. Compared with obstructive CAD patients, nonobstructive CAD patients had significantly lower rates of rates of aspirin (72.7% versus 90.9%), statin (60.0% versus 80.3%), β-blocker (57.9% versus 79.4%), and ACEI/ARB (45.9% versus 58.6%; all probability values <0.0001) prescription at hospital discharge. After multivariable adjustment, nonobstructive CAD patients remained significantly less likely to receive prescriptions for aspirin (odds ratio, 0.37; 95% confidence interval, 0.35 to 0.39), statins (odds ratio, 0.45; 95% confidence interval, 0.43 to 0.48), β-blockers (odds ratio, 0.46; 95% CI, 0.44 to 0.47), or ACEI/ARBs (odds ratio, 0.83; 95% confidence interval, 0.8 to 0.86) compared with obstructive CAD patients. Secondary analyses of selected subgroups supported the primary findings.
Patients with nonobstructive CAD were significantly less likely to receive secondary prevention medication prescription at hospital discharge, as compared with patients with obstructive CAD. These findings highlight an opportunity to improve the quality of care for CAD patients with nonobstructive disease.
二级预防疗法适用于冠状动脉疾病（CAD）患者。然而，与阻塞性CAD患者相比，非阻塞性CAD患者接受这些疗法的可能性可能较低。因此，我们比较了非阻塞性和阻塞性CAD患者二级预防药物处方的比例。
我们对2004年至2007年间在美国786个中心接受心导管检查的1489745例CAD患者进行了一项回顾性队列研究。我们测量了符合条件的患者出院时阿司匹林、他汀类药物、β受体阻滞剂和血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）的处方比例；237167例（15.9%）患者患有非阻塞性CAD，1252578例（84.1%）患有阻塞性CAD。与阻塞性CAD患者相比，非阻塞性CAD患者出院时阿司匹林（72.7%对90.9%）、他汀类药物（60.0%对80.3%）、β受体阻滞剂（57.9%对79.4%）和ACEI/ARB（45.9%对58.6%；所有概率值<0.0001）的处方比例显著较低。经过多变量调整后，与阻塞性CAD患者相比，非阻塞性CAD患者接受阿司匹林（比值比，0.37；95%置信区间，0.35至0.39）、他汀类药物（比值比，0.45；95%置信区间，0.43至0.48）、β受体阻滞剂（比值比，0.46；95%CI，0.44至0.47）或ACEI/ARB（比值比，0.83；95%置信区间，0.8至0.86）处方的可能性仍然显著较低。对选定亚组的二次分析支持了主要发现。
与阻塞性CAD患者相比，非阻塞性CAD患者出院时接受二级预防药物处方的可能性显著较低。这些发现凸显了改善非阻塞性疾病CAD患者护理质量的机会。
