Chow Clara K, Brieger David, Ryan Mark, Kangaharan Nadarajah, Hyun Karice K, Briffa Tom
Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia.
The George Institue of Global Health, Perth, Western Australia, Australia.
Heart Asia. 2019 Jan 12;11(1):e011122. doi: 10.1136/heartasia-2018-011122. eCollection 2019.
To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes.
CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months' follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death.
The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62).
Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
确定急性冠状动脉综合征（ACS）后二级预防药物的使用情况及心脏康复情况，以及对2年预后的影响。
CONCORDANCE（急性冠状动脉护理、指南依从性和临床事件合作国家登记处）是一项对41家澳大利亚医院进行的前瞻性观察性登记研究。纳入了6859例ACS患者的代表性样本，并于2016年5月31日进行了6个月的随访。主要结局指标是使用≥75%的指定药物（血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、降脂治疗、阿司匹林和其他抗血小板药物中≥4/5（或如有禁忌则≥3/4））。主要不良心血管事件（MACE）包括心肌梗死、中风或心血管死亡。
平均年龄为65±13岁，29%为女性，急性冠状动脉事件全球登记处（GRACE）平均评分为106±30。出院时，92%的患者服用阿司匹林，93%接受降脂治疗，78%服用β受体阻滞剂，74%服用ACE/血管紧张素受体阻滞剂，73%服用第二种抗血小板药物；89%的患者出院时服用≥75%的药物，6个月时为78%，2年时为66%。6个月时，38%的患者参加了心脏康复，58%的患者接受了饮食建议，32%的吸烟者报告戒烟。在1896例随访2年的患者中，服用≥75%药物的患者与服用<75%药物的患者相比，死亡/MACE的发生率较低（8.3%对13.9%；调整后的比值比为0.75，95%置信区间为0.56至0.99），参加心脏康复的患者与未参加心脏康复的患者相比发生率较低（4.6%对13.4%；调整后的比值比为0.44，95%置信区间为0.31至0.62）。
ACS后二级预防治疗的使用随时间推移而减少。接受二级预防的患者2年时死亡和MACE发生率降低。
