Peng Yong, Xia Tian-Li, Huang Fang-Yang, Huang Bao-Tao, Liu Wei, Chai Hua, Zhao Zhen-Gang, Zhang Chen, Liao Yan-Biao, Pu Xiao-Bo, Chen Shi-Jian, Li Qiao, Xu Yuan-Ning, Luo Yang, Chen Mao, Huang De-Jia
From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2016 Feb;95(6):e2740. doi: 10.1097/MD.0000000000002740.
The purpose of this study was to discuss the present situation of discharge medications in coronary artery disease (CAD) patients with different levels of renal function and assess the potential impact of these medications on the prognosis of this patient population.A retrospective cohort study was conducted. From July 2008 to Jan 2012, consecutive patients with CAD confirmed by coronary angiography of West China Hospital were enrolled and were grouped into 3 estimated glomerular filtration rate (eGFR) categories: ≥60, 30 to 60, and <30 mL/min/1.73 m. The endpoints were all-cause mortality and cardiac mortality.There are 3002 patients according to the inclusion criteria and follow-up requirement. The mean follow-up time was 29.1 ± 12.5 months. CAD patients with worse renal function included more cardiovascular risk factors (advanced age, history of hypertension or diabetes, and diagnosis of acute myocardial infarction). The cumulative survival curves of the patients according to renal function showed that the eGFR <30 mL/min and 30 mL/min ≤ eGFR <60 mL/min groups had a significantly higher risk of all-cause death and cardiovascular death than the group with an eGFR ≥60 mL/min. The prescription of evidence-based medicines (EBMs) at discharge (antiplatelet agents, beta-blockers, statins, and angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin-receptor blockers [ARBs]) was a factor in reducing the risk of all-cause death and cardiovascular death. However, EBMs prescribed at discharge revealed an obvious underuse in renal insufficiency (RI) patients. The results of Cox regression showed that irrespective of the eGFR level, greater use of EBMs resulted in a greater reduction in the risk of all-cause death and cardiovascular death.A higher percentage of patients with CAD and concomitant RI suffered from cardiovascular disease (CVD) risk factors, whereas a lower percentage of these patients used EBMs to prevent CVD events. Strict use of EBMs, including beta-blockers, statins, and ACEIs or ARBs, can lead to more clinical benefits, even for patients with CAD and concomitant RI. Thus, treatment of this patient population with EBMs should be stressed.
本研究旨在探讨不同肾功能水平的冠状动脉疾病（CAD）患者出院用药现状，并评估这些药物对该患者群体预后的潜在影响。开展了一项回顾性队列研究。2008年7月至2012年1月，纳入了在华西医院经冠状动脉造影确诊为CAD的连续患者，并将其分为3个估计肾小球滤过率（eGFR）类别：≥60、30至60以及<30 mL/min/1.73 m²。终点指标为全因死亡率和心脏死亡率。
根据纳入标准和随访要求，共有3002例患者。平均随访时间为29.1±12.5个月。肾功能较差的CAD患者包含更多心血管危险因素（高龄、高血压或糖尿病病史以及急性心肌梗死诊断）。根据肾功能绘制的患者累积生存曲线显示，eGFR<30 mL/min组和30 mL/min≤eGFR<60 mL/min组的全因死亡和心血管死亡风险显著高于eGFR≥60 mL/min组。出院时开具循证药物（EBMs，即抗血小板药物、β受体阻滞剂、他汀类药物以及血管紧张素转换酶抑制剂[ACEIs]或血管紧张素受体阻滞剂[ARBs]）是降低全因死亡和心血管死亡风险的一个因素。然而，出院时开具的EBMs在肾功能不全（RI）患者中明显使用不足。Cox回归结果显示，无论eGFR水平如何，更多地使用EBMs可更大程度降低全因死亡和心血管死亡风险。
CAD合并RI的患者中，患有心血管疾病（CVD）危险因素的比例较高，而使用EBMs预防CVD事件的患者比例较低。严格使用EBMs，包括β受体阻滞剂、他汀类药物以及ACEIs或ARBs，即使对于CAD合并RI的患者也可带来更多临床益处。因此，应强调对该患者群体使用EBMs进行治疗。
