Byeon Hee Ja, Yang Young-Mo, Choi Eun Joo
Department of Pharmacy, Chosun University Hospital, Gwangju, South Korea.
Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea.
Ther Clin Risk Manag. 2016 Feb 12;12:167-75. doi: 10.2147/TCRM.S99869. eCollection 2016.
Acute coronary syndrome (ACS) is a fatal cardiovascular disease caused by atherosclerotic plaque erosion or rupture and formation of coronary thrombus. The latest guidelines for ACS recommend the combined drug regimen, comprising aspirin, P2Y12 inhibitor, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, β-blocker, and statin, at discharge after ACS treatment to reduce recurrent ischemic cardiovascular events. This study aimed to examine prescription patterns of secondary prevention drugs in Korean patients with ACS after hospital discharge, to access the appropriateness of secondary prevention drug therapy for ACS, and to evaluate whether to persistently use discharge medications for 18 months.
This study was retrospectively conducted with the patients who were discharged from the tertiary hospital, located in South Korea, after ACS treatment between September 2009 and August 2013. Data were collected through electronic medical record.
Among 3,676 patients during the study period, 494 were selected based on inclusion and exclusion criteria. The regimen of aspirin + clopidogrel + β-blocker + angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker + statin was prescribed to 374 (75.71%) patients with ACS at discharge. Specifically, this regimen was used in 177 (69.69%) unstable angina patients, 44 (70.97%) non-ST-segment elevation myocardial infarction patients, and 153 (85.96%) ST-segment elevation myocardial infarction patients. Compared with the number of ACS patients with all five guideline-recommended drugs at discharge, the number of ACS patients using them 12 (n=169, 34.21%) and 18 (n=105, 21.26%) months after discharge tended to be gradually decreased.
The majority of ACS patients in this study received all five guideline-recommended medications at discharge from the hospital. However, the frequency of using all of them had been gradually decreased 3, 6, 12, and 18 months after discharge compared with that at discharge. Careful monitoring of adherence on ACS secondary prevention medications may help improve the outcomes of ACS patients in terms of recurrent ischemic cardiovascular events.
急性冠状动脉综合征（ACS）是一种由动脉粥样硬化斑块侵蚀或破裂以及冠状动脉血栓形成引起的致命性心血管疾病。最新的ACS指南推荐在ACS治疗出院后采用联合药物治疗方案，包括阿司匹林、P2Y12抑制剂、血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂、β受体阻滞剂和他汀类药物，以减少复发性缺血性心血管事件。本研究旨在调查韩国ACS患者出院后二级预防药物的处方模式，评估ACS二级预防药物治疗的合理性，并评估是否持续使用出院药物达18个月。
本研究对2009年9月至2013年8月在韩国一家三级医院接受ACS治疗后出院的患者进行回顾性研究。数据通过电子病历收集。
在研究期间的3676例患者中，根据纳入和排除标准选择了494例。出院时，374例（75.71%）ACS患者接受了阿司匹林+氯吡格雷+β受体阻滞剂+血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂+他汀类药物的治疗方案。具体而言，该方案在177例（69.69%）不稳定型心绞痛患者、44例（70.97%）非ST段抬高型心肌梗死患者和153例（85.96%）ST段抬高型心肌梗死患者中使用。与出院时使用所有五种指南推荐药物的ACS患者数量相比，出院后12个月（n = 169，34.21%）和18个月（n = 105，21.26%）使用这些药物的ACS患者数量呈逐渐下降趋势。
本研究中的大多数ACS患者出院时接受了所有五种指南推荐的药物治疗。然而，与出院时相比，出院后3、6、12和18个月同时使用所有这些药物的频率逐渐下降。密切监测ACS二级预防药物的依从性可能有助于改善ACS患者复发性缺血性心血管事件的结局。
