经皮冠状动脉介入治疗后基于指南的医学治疗应用的差异：来自日本前瞻性多中心注册研究的分析。

Disparity in the application of guideline-based medical therapy after percutaneous coronary intervention: analysis from the Japanese prospective multicenter registry.

机构信息

Department of Cardiology, Keio University School of Medicine, and Department of Cardiology, Tachikawa Hospital, Tokyo, Japan.

出版信息

Am J Cardiovasc Drugs. 2013 Apr;13(2):103-12. doi: 10.1007/s40256-013-0021-8.

DOI:10.1007/s40256-013-0021-8

PMID:23585142

Abstract

BACKGROUND

Despite the known benefits of evidence-based medical care in patients with coronary artery disease, disparities exist in the application of guideline-based medical therapy (GBMT) after percutaneous coronary intervention (PCI), particularly in patients who have undergone revascularization procedures. Underestimation of risk, overestimation of side effects, and preference of the treating physician to prioritize invasive procedures may all affect the prescription pattern.

OBJECTIVE

We sought to describe how GBMT is prescribed after PCI in Japan.

METHODS

From September 2008 to 2010, 1,612 patients underwent PCI with stenting at 14 Japanese hospitals participating in the Japanese Cardiovascular Database Registry. GBMT was defined as treatment including dual antiplatelet therapy, beta-adrenoceptor antagonists (beta-blockers) and/or calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and statins.

RESULTS

Overall, 749 patients (46.5%) were discharged on GBMT. Notably, the prescription rate of GBMT became lower with age (e.g. from 50.3% [age 50-59 years] to 35.9% [age over 80 years]). In addition, patients presenting with acute coronary syndrome (ACS) tended to receive GBMT more frequently (ST-segment elevation myocardial infarction [STEMI] 33.8 vs. 18.3%; p<0.001; non-ST-segment elevation myocardial infarction [NSTEMI] 8.5 vs. 5.9%; p=0.042), whereas patients presenting with cardiogenic shock (CS) had lower prescription rates of GBMT (2.1 vs. 4.1%; p=0.032). Overall age (odds ratio [OR] 0.647; p=0.020), as well as the acute and emergent presentation (OR 3.229; p<0.001 for STEMI; OR 2.122; p<0.001 for NSTEMI; OR 0.35; p=0.002 for CS) were also associated with prescription of GBMT.

CONCLUSION

Only about half of the post-PCI patients were discharged on ideal GBMT. Elderly patients and those presenting with non-ACS status or hemodynamic compromise tended not to receive GBMT, and required more attention for optimization of their care.

摘要

背景

尽管循证医学治疗在冠心病患者中具有已知的益处，但在经皮冠状动脉介入治疗（PCI）后，指南指导的药物治疗（GBMT）的应用仍存在差异，尤其是在接受血运重建手术的患者中。对风险的低估、对副作用的高估以及治疗医生优先选择侵入性手术的偏好，都可能影响处方模式。

目的

我们旨在描述日本 PCI 后 GBMT 的开具情况。

方法

2008 年 9 月至 2010 年，14 家日本医院的 1612 例患者接受了 PCI 支架置入术。GBMT 定义为包括双联抗血小板治疗、β受体阻滞剂（β阻滞剂）和/或钙通道阻滞剂、血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂和他汀类药物的治疗。

结果

总体而言，749 例（46.5%）患者出院时接受了 GBMT。值得注意的是，随着年龄的增长（例如，年龄 50-59 岁的患者为 50.3%，年龄超过 80 岁的患者为 35.9%），GBMT 的处方率降低。此外，急性冠状动脉综合征（ACS）患者更倾向于接受 GBMT（ST 段抬高心肌梗死[STEMI]为 33.8%比 18.3%；p<0.001；非 ST 段抬高心肌梗死[NSTEMI]为 8.5%比 5.9%；p=0.042），而心源性休克（CS）患者的 GBMT 处方率较低（2.1%比 4.1%；p=0.032）。总体年龄（比值比[OR]0.647；p=0.020）以及急性和紧急情况（STEMI 的 OR 为 3.229；p<0.001；NSTEMI 的 OR 为 2.122；p<0.001；CS 的 OR 为 0.35；p=0.002）也与 GBMT 的开具相关。