Swieczkowski Damian, Mogielnicki Mariusz, Cwalina Natalia, Zuk Grzegorz, Pisowodzka Izabela, Ciecwierz Dariusz, Gruchala Marcin, Jaguszewski Milosz
1st Department of Cardiology, Medical University of Gdansk, Poland.
Research & Development Laboratory, OCEANIC S.A., Poland.
Cardiol J. 2016;23(5):483-490. doi: 10.5603/CJ.a2016.0048. Epub 2016 Jul 21.
Adherence to medication is one of the most significant challenges of secondary prevention in patients after an acute myocardial infarction (AMI). Indeed, it has been well established that higher adherence is associated with better cardiovascular outcomes. Research pertaining to secondary prevention after AMI treated with percutaneous coronary intervention (PCI) focuses mainly on the adherence to antiplatelet therapy. Adherence levels have been found to be particularly poor and thus, insufficient with regards to prevention; with a high rate of discontinuation of therapy occurring during the 12-month follow-up. There are numerous predicting factors associated with non-adherence to antiplatelet therapy in patients after PCI. These include, but are not limited to, a lack of education on antiplatelet treatment, various comorbidities, depression, or even, unmarried status. Financial limitations of the patient also play a relevant role, however, the nature of this impediment is problematic and requires further investigation. It would seem beneficial to carry out advanced research based on a randomized and double-blind protocol, however, large-cohort, real-world observations are also essential to investigate non-adherence across a broad array of treatment settings above and beyond the scope of prospective clinical trials. Research about adherence under the context of invasive treatment of AMI has a tremendous practical impact and should be considered a matter of importance concerning both clinicians and scientists. Close collaboration between not only researchers, health practitioners, i.e. physicians and pharmacists, but also politicians, is strongly recommended to aid in designing an intervention that might improve patient adherence.
坚持服药是急性心肌梗死（AMI）患者二级预防面临的最重大挑战之一。事实上，已有充分证据表明，更高的服药依从性与更好的心血管结局相关。关于经皮冠状动脉介入治疗（PCI）后AMI患者二级预防的研究主要集中在抗血小板治疗的依从性上。研究发现，依从性水平特别低，因此在预防方面不足；在12个月的随访期间，治疗中断率很高。PCI术后患者不坚持抗血小板治疗有许多预测因素。这些因素包括但不限于缺乏抗血小板治疗教育、各种合并症、抑郁症，甚至未婚状态。患者的经济限制也起到了相关作用，然而，这种障碍的性质存在问题，需要进一步研究。开展基于随机双盲方案的深入研究似乎是有益的，不过，大样本队列的真实世界观察对于调查超出前瞻性临床试验范围的广泛治疗环境中的不依从性也至关重要。关于AMI侵入性治疗背景下依从性的研究具有巨大的实际影响，应被视为临床医生和科学家都非常重视的问题。强烈建议研究人员、健康从业者（即医生和药剂师）以及政治家之间密切合作，以协助设计可能提高患者依从性的干预措施。
