Pol Arch Intern Med. 2017 Jan 20;127(2):107-114. doi: 10.20452/pamw.3902.
INTRODUCTION Clinical outcomes of patients with stable coronary artery disease (CAD) may differ between those primarily managed by cardiologists versus noncardiologists. OBJECTIVES Our main objective was to analyze the clinical outcomes of outpatients with stable CAD in relation to the specialty of the managing physicians. PATIENTS AND METHODS We studied 32 468 outpatients with stable CAD included in the CLARIFY registry, with up to 4 years of follow‑up data. Cardiologists provided medical care in 84.1% and noncardiologists in 15.9% of the patients. Primary outcome was the composite of cardiovascular death, nonfatal myocardial infarction (MI), or stroke. RESULTS Important differences in management as well as demographic and clinical characteristics were observed between the groups at baseline. Patients treated by cardiologists were younger and more of them had dyslipidemia, hypertension, and diabetes. The use of β‑blockers and thienopyridines, as well as history of percutaneous coronary intervention were more frequent in this group. More patients treated by noncardiologists had a history of MI as well as concomitant peripheral artery disease and asthma or chronic obstructive pulmonary disease. They also had lower left ventricular ejection fraction and more often received lipid‑lowering drugs. After adjustment for baseline differences, patients treated by cardiologists had a lower risk of the primary outcome (adjusted hazard ratio, 0.80; 95% confidence interval, 0.68–0.94; P = 0.0067) and of most secondary outcomes, but greater risk of bleeding. CONCLUSIONS Outpatients with stable CAD managed by cardiologists had a lower rate of cardiovascular outcomes than those managed by noncardiologists. We did not find clear evidence that cardiologists provided superior guideline‑based treatment, so the differences in outcome were most likely due to unquantifiable differences in patient characteristics.
稳定型冠状动脉疾病（CAD）患者的临床结局可能因主要由心脏病专家还是非心脏病专家管理而有所不同。目的：我们的主要目的是分析与管理医生的专业相关的稳定型 CAD 门诊患者的临床结局。患者和方法：我们研究了 CLARIFY 登记处中 32468 例稳定型 CAD 门诊患者，随访数据最长达 4 年。84.1%的患者由心脏病专家提供医疗服务，15.9%的患者由非心脏病专家提供医疗服务。主要结局是心血管死亡、非致死性心肌梗死（MI）或卒中的复合结局。结果：在基线时，两组患者在管理以及人口统计学和临床特征方面存在显著差异。心脏病专家治疗的患者更年轻，且更多的患者患有血脂异常、高血压和糖尿病。该组更常使用β受体阻滞剂和噻吩吡啶类药物，以及经皮冠状动脉介入治疗史。更多非心脏病专家治疗的患者有 MI 史、同时患有外周动脉疾病和哮喘或慢性阻塞性肺疾病。他们的左心室射血分数也较低，更常接受降脂药物治疗。在调整基线差异后，心脏病专家治疗的患者主要结局（校正后危险比，0.80；95%置信区间，0.68–0.94；P=0.0067）和大多数次要结局的风险较低，但出血风险较高。结论：与非心脏病专家管理的患者相比，由心脏病专家管理的稳定型 CAD 门诊患者的心血管结局发生率较低。我们没有发现明确的证据表明心脏病专家提供了更优的基于指南的治疗，因此，结局的差异很可能是由于患者特征的不可量化差异所致。
