Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
Centre Hospitalier Régional et Universitaire de Lille, Lille, France Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France Faculté de Médecine de Lille, Lille, France.
Eur J Prev Cardiol. 2015 Jul;22(7):864-71. doi: 10.1177/2047487314538857. Epub 2014 Jun 9.
To assess the level of secondary prevention and the outcome of coronary artery disease (CAD) in patients who have a history of non-coronary vascular intervention.
Patients with polyvascular disease have been reported to receive less evidence-based medications, with worse risk factor control and to be at higher risk than patients with single-bed disease. It is unknown whether these findings remain valid in the modern era of secondary prevention.
We included 4184 patients with stable CAD. Two groups were formed according to the absence (n = 3704) or presence (n = 480) of a history of non-coronary vascular intervention. Treatments and risk factor control were recorded at inclusion. Follow-up was performed after 2 years.
Antiplatelets, angiotensin system antagonists, beta-blockers and statins were widely prescribed in both groups. The number of antihypertensive drugs was higher in patients with non-coronary vascular intervention. Except for slight increases in the rate of current smokers and in systolic blood pressure, risk factor control was similar between groups. All-cause and cardiovascular mortality rates were higher in patients with non-coronary intervention with adjusted HR of 1.55 (1.13-2.13) (p = 0.007), and 1.98 (1.24-3.15) (p = 0.004), respectively.
In modern practice and real life conditions, the higher risk of CAD patients with a history of non-coronary vascular intervention is taken into account, with more intense secondary prevention and similar risk factor control than patients without such history. In spite of the level of secondary prevention, patients with a history of non-coronary vascular intervention remain at high risk of cardiovascular events. This should be an incentive to discuss more stringent objectives for secondary prevention in patients with polyvascular disease.
评估有非冠状动脉血管介入治疗史的冠心病（CAD）患者的二级预防水平和结局。
已有研究报道，多血管疾病患者接受的循证药物治疗较少，危险因素控制较差，风险高于单血管疾病患者。但在现代二级预防时代，这些发现是否仍然成立尚不清楚。
我们纳入了 4184 例稳定型 CAD 患者。根据是否存在（n=3704）或不存在（n=480）非冠状动脉血管介入治疗史将患者分为两组。记录纳入时的治疗和危险因素控制情况。随访 2 年后进行。
两组均广泛使用抗血小板药物、血管紧张素系统拮抗剂、β受体阻滞剂和他汀类药物。有非冠状动脉血管介入治疗史的患者使用的降压药物数量更多。除了现吸烟者和收缩压略有增加外，两组的危险因素控制情况相似。有非冠状动脉介入治疗史的患者全因死亡率和心血管死亡率均较高，调整后的 HR 分别为 1.55（1.13-2.13）（p=0.007）和 1.98（1.24-3.15）（p=0.004）。
在现代实践和真实生活条件下，考虑到有非冠状动脉血管介入治疗史的 CAD 患者的风险较高，给予了更强化的二级预防治疗，且危险因素控制情况与无此类病史的患者相似。尽管进行了二级预防，但有非冠状动脉血管介入治疗史的患者仍有发生心血管事件的高风险。这应该促使我们与多血管疾病患者更深入地讨论二级预防的更严格目标。
