Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Eur J Prev Cardiol. 2013 Apr;20(2):218-28. doi: 10.1177/2047487312437060. Epub 2012 Jan 24.
Despite common European Society of Cardiology recommendations, adherence to guideline therapy varies, both temporally and geographically. We sought to examine current differences in the use of guideline-recommended therapies among 14 European countries in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
Data were obtained from the Antiplatelet Therapy Observational Registry (APTOR), a non-interventional, prospective observational cohort study enrolling patients with ACS undergoing PCI. Medication data were captured through 1 year. The large majority of patients in the APTOR registry received statins at hospital discharge (89%) and remained on statins at 1 year (87%), a finding that was consistent across countries. Likewise, beta-blocker use was similar at discharge and 1 year (83 and 81%, respectively). There was large disparity in aspirin loading dose between countries, but the discharge maintenance dose was more consistent, with most receiving ≤ 100 mg (87%). While 95% of patients were discharged on dual antiplatelet therapy, 71% remained on both treatments by 1 year, with wide variation by country in 1-year use.
These data from the APTOR study provide key information on current European ACS patient care management from hospitalization through 1 year. Even with European Society of Cardiology (ESC) guidelines, variations in practice patterns exist among ACS patients treated with PCI between the 14 European countries studied, including the use of proven therapies, as well as appropriate duration and dosing of antiplatelet regimens. Efforts are needed to further explain why such variation exists and to continue to improve adherence to ESC guidelines to improve patient care.
尽管有欧洲心脏病学会的普遍建议，但指南治疗的依从性在时间和地理上都存在差异。我们试图研究在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，14 个欧洲国家目前在指南推荐治疗方法的使用上存在哪些差异。
数据来自抗血小板治疗观察性登记（APTOR），这是一项非干预性、前瞻性观察队列研究，纳入接受 PCI 的 ACS 患者。通过 1 年时间获取药物治疗数据。在 APTOR 登记研究中，绝大多数患者在出院时接受了他汀类药物治疗（89%），并在 1 年内继续使用他汀类药物（87%），这一发现在各国都是一致的。同样，出院时和 1 年时β受体阻滞剂的使用率相似（分别为 83%和 81%）。各国之间阿司匹林负荷剂量存在很大差异，但出院维持剂量更为一致，大多数患者接受≤100mg 剂量（87%）。尽管 95%的患者出院时接受双联抗血小板治疗，但 1 年内仍有 71%的患者同时接受两种治疗，各国之间 1 年内的使用情况存在很大差异。
APTOR 研究提供了关于目前欧洲 ACS 患者从住院到 1 年期间的关键护理管理信息。即使有了欧洲心脏病学会（ESC）的指南，在接受 PCI 治疗的 ACS 患者中，14 个研究国家之间的实践模式仍存在差异，包括使用已证实的治疗方法，以及抗血小板方案的适当持续时间和剂量。需要努力进一步解释为什么会存在这种差异，并继续提高对 ESC 指南的依从性，以改善患者的护理。
