Ertaş Fatih Sinan, Tokgozoglu Lale
Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2018 Apr;46(3):175-183. doi: 10.5543/tkda.2017.66724.
The aim of this study was to evaluate the longterm, post-discharge follow-up of antithrombotic management patterns (AMPs), clinical outcomes, and real-life health status of patients hospitalized acute coronary syndrome (ACS).
A total of 1034 patients hospitalized for ACS within 24 hours of symptom onset who survived to discharge were included. Of those, 514 had ST-segment elevation myocardial infarction (STEMI) and 520 had unstable angina (UA)/non-STEMI (NSTEMI). Data on follow-up AMPs, clinical outcomes, and health status were collected during 24 months of follow-up.
The overall all-cause mortality was 6.4% (6.7% in UA/NSTEMI and 6.0% in STEMI patients), cardiovascular (CV) events had occurred in 9.4% (9.8% in UA/NSTEMI and 8.9% in STEMI patients), and bleeding events in 2.0% (2.3% in STEMI and 1.7% in UA/NSTEMI patients) of patients at 2 years after discharge. EuroQol-visual analogue scales scores increased from 78.9 to 81.6 in STEMI patients, and from 76.0 to 76.2 in UA/NSTEMI patients. Discharge and 2-year postdischarge scores for the EuroQol-5D index were 0.7 and 0.9, respectively in STEMI patients, while it was 0.8 for each period in UA/STEMI patients. Overall, 57.5% of the patients on dual antiplatelet (AP) therapy at discharge remained on this treatment at 2 years after discharge. The use of 1AP/0 anticoagulant (AC) and ≥2AP/0AC were associated with a CV event risk of 10.5% and 8.9%, a mortality risk of 10.5% and 5.8%, and a bleeding event risk of 0.9% and. 2.2%, respectively.
These findings in a real-life population of ACS patients emphasize the importance of longer-term follow-up of ACS patients surviving hospitalization and support the likelihood of more favorable long-term outcomes in ACS management with the current treatment practices.
本研究旨在评估急性冠状动脉综合征（ACS）住院患者出院后的长期抗栓治疗管理模式（AMPs）、临床结局及实际健康状况。
纳入1034例症状发作24小时内住院且存活至出院的ACS患者。其中，514例为ST段抬高型心肌梗死（STEMI），520例为不稳定型心绞痛（UA）/非ST段抬高型心肌梗死（NSTEMI）。在24个月的随访期间收集随访AMPs、临床结局及健康状况的数据。
出院2年后，总体全因死亡率为6.4%（UA/NSTEMI患者为6.7%，STEMI患者为6.0%），心血管（CV）事件发生率为9.4%（UA/NSTEMI患者为9.8%，STEMI患者为8.9%），出血事件发生率为2.0%（STEMI患者为2.3%，UA/NSTEMI患者为1.7%）。STEMI患者的欧洲五维健康量表视觉模拟量表评分从78.9提高到81.6，UA/NSTEMI患者从76.0提高到76.2。STEMI患者出院时及出院2年时的欧洲五维健康量表5维度指数评分分别为0.7和0.9，而UA/NSTEMI患者各时期均为0.8。总体而言，出院时接受双联抗血小板（AP）治疗的患者中，57.5%在出院2年后仍接受该治疗。使用1种抗血小板药物/0种抗凝药物（AC）和≥2种抗血小板药物/0种抗凝药物的患者发生CV事件的风险分别为10.5%和8.9%，死亡风险分别为10.5%和5.8%，出血事件风险分别为0.9%和2.2%。
这些在ACS患者真实人群中的研究结果强调了对存活出院的ACS患者进行长期随访的重要性，并支持当前治疗方法在ACS管理中实现更有利长期结局的可能性。
