Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey.
J Clin Pharm Ther. 2013 Dec;38(6):476-9. doi: 10.1111/jcpt.12091. Epub 2013 Aug 31.
Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone.
We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records.
Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)].
In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.
尽管许多研究已经检查了冠心病（CAD）患者的药物依从性，但没有前瞻性试验比较过经皮冠状动脉介入治疗（PCI）与最佳药物治疗（OMT）的患者之间的药物依从性。本研究旨在比较有记录的 CAD 患者接受 PCI 和 OMT 或单独 OMT 治疗后的循证二级预防药物的依从性。
我们在 232 例有记录的 CAD 患者中评估了 6 个月的随访期间他汀类药物、β受体阻滞剂和血管紧张素转换酶抑制剂（ACEI）的依从性，比较了接受 PCI 治疗和仅接受药物治疗的患者。药物依从性是根据国家报销数据库记录来衡量的。
在 232 例存活至 6 个月随访的患者中，根据处方记录（预先指定的主要终点），PCI 组的依从患者百分比为 53.6%（n=82），OMT 组为 33.8%（n=27）（P=0.004）。对个别药物类别的分析显示，β受体阻滞剂（PCI 组为 86.0%，OMT 组为 72.5%，P=0.006）和他汀类药物（PCI 组为 64.5%，OMT 组为 44.0%，P=0.003）的结果相似。ACEI 的依从性在 PCI 组也更高，但差异无统计学意义（77.6%比 69.3%，P=0.17）。通过逻辑回归分析，属于 PCI 组是药物依从性的独立预测因子[B=2.20（1.06-4.50），P=0.03)]。
在本研究中，我们证明了与单独接受 OMT 治疗的患者相比，接受 PCI 治疗的患者对循证药物治疗的依从性明显更高。接受 OMT 治疗的 CAD 患者应密切关注药物依从性。
