Saint Luke's Mid America Heart Institute, Kansas City, MO
University of Missouri-Kansas City, Kansas City, MO.
J Am Heart Assoc. 2017 Oct 20;6(10):e006405. doi: 10.1161/JAHA.117.006405.
Antianginal medications (AAMs) can be perceived to be less important after percutaneous coronary intervention (PCI) and may be de-escalated after revascularization. We examined the frequency of AAM de-escalation at discharge post-PCI and its association with follow-up health status.
In a 10-center PCI registry, the Seattle Angina Questionnaire was assessed before and 6 months post-PCI. AAM de-escalation was defined as fewer AAMs at discharge versus admission or >25% absolute dose decrease. Of 2743 PCI patients (70% male), AAM were de-escalated, escalated, and unchanged in 299 (11%), 714 (26%), and 1730 (63%) patients, respectively. Patients whose AAM were de-escalated were more likely to report angina at 6 months, compared with unchanged or escalated AAM (34% versus 24% versus 21%; <0.001). The association of AAM de-escalation with health status was examined using multivariable models adjusting for the predicted risk of post-PCI angina, completeness of revascularization, and the interaction of AAM de-escalation×completeness of revascularization. There was a significant interaction between AAM de-escalation and completeness of revascularization (<0.001), suggesting that AAM de-escalation was associated with greater impairment of health status among patients with incomplete revascularization. In patients with incomplete revascularization, de-escalation of AAM at discharge was associated with 43% increased angina risk (relative risk, 1.43; 95% confidence interval, 1.26-1.63) and worse angina-related health status at 6 months post-PCI.
De-escalation of AAM occurs in 1 in 10 patients post-PCI, and it is associated with an increased risk of angina and worse health status, particularly among those with incomplete revascularization.
经皮冠状动脉介入治疗（PCI）后，人们可能会认为抗心绞痛药物（AAMs）不那么重要，并且在血运重建后可能会减少剂量。我们研究了 PCI 后出院时 AAMs 剂量减少的频率及其与随访健康状况的关系。
在一个 10 中心 PCI 注册研究中，西雅图心绞痛问卷（SAQ）在 PCI 术前和术后 6 个月进行评估。AAMs 剂量减少定义为出院时与入院时相比，AAMs 种类减少或绝对剂量减少>25%。在 2743 例 PCI 患者（70%为男性）中，分别有 299 例（11%）、714 例（26%）和 1730 例（63%）患者的 AAMs 剂量减少、增加或不变。与 AAMs 剂量不变或增加的患者相比，AAMs 剂量减少的患者在 6 个月时更有可能报告心绞痛（34%比 24%比 21%；<0.001）。使用多变量模型，调整 PCI 后心绞痛的预测风险、血运重建的完整性以及 AAMs 剂量减少与血运重建完整性的交互作用，检验了 AAMs 剂量减少与健康状况之间的关系。AAMs 剂量减少与血运重建完整性之间存在显著的交互作用（<0.001），提示在血运重建不完全的患者中，AAMs 剂量减少与健康状况的恶化更相关。在血运重建不完全的患者中，出院时 AAMs 剂量减少与心绞痛风险增加 43%（相对风险，1.43；95%置信区间，1.26-1.63）和 PCI 术后 6 个月时更差的心绞痛相关健康状况相关。
10 例 PCI 患者中就有 1 例会减少 AAMs 剂量，这与心绞痛风险增加和健康状况恶化相关，尤其是在血运重建不完全的患者中。
