外科手术与经皮冠状动脉血运重建中预防性心血管药物治疗的比较
Comparison of Preventive Cardiovascular Pharmacotherapy in Surgical vs Percutaneous Coronary Revascularization.
作者信息
Barry Arden R, Wang Erica H Z, Chua Doson, Pearson Glen J
机构信息
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, British Columbia, Canada.
出版信息
CJC Open. 2019 Oct 19;1(6):297-304. doi: 10.1016/j.cjco.2019.09.001. eCollection 2019 Nov.
BACKGROUND
Data suggest that patients who undergo coronary artery bypass grafting (CABG) have a lower rate of secondary preventive cardiovascular pharmacotherapy use compared with patients who undergo percutaneous coronary intervention (PCI). This study sought to assess the rate of use of preventive pharmacotherapy at discharge in patients who underwent CABG vs PCI post-acute coronary syndrome (ACS).
METHODS
A prospective cohort study was conducted at St Paul's Hospital in Vancouver, Canada. Patients aged ≥ 18 years who presented with an ACS and underwent CABG or PCI between January and November 2018 were included. Data on preventive pharmacotherapy use and reasons for justified nonuse (eg, intolerance, contraindication) were collected.
RESULTS
A total of 275 patients were included. Mean age was 65 years, and 83% were male. Overall, 141 patients (51%) underwent CABG and 134 patients (49%) underwent PCI. All patients received acetylsalicylic acid, but more patients who underwent CABG received 325 mg (vs 80-81 mg) compared to PCI (25% vs 1%, 0.01). Use of P2Y12 inhibitors was higher in patients who underwent PCI (primarily ticagrelor) compared with patients who underwent CABG (primarily clopidogrel) (99% vs 26%, 0.01). All patients who underwent CABG received a β-blocker vs 96% of patients who underwent PCI ( 0.017). Use of angiotensin-modulating agents was higher in patients who underwent PCI (98% vs 65%, 0.01). Statin use was similar between groups (99% vs 99%, 0.96), but more patients who underwent PCI received maximum-dose therapy (89% vs 64%, 0.01).
CONCLUSIONS
Use of acetylsalicylic acid, β-blockers, and statins in patients post-ACS was high regardless of revascularization strategy, whereas P2Y12 inhibitors and angiotensin-modulating agents were underused in patients who underwent CABG even after adjusting for justified nonuse.
背景
数据表明，与接受经皮冠状动脉介入治疗（PCI）的患者相比，接受冠状动脉旁路移植术（CABG）的患者二级预防性心血管药物治疗的使用率较低。本研究旨在评估急性冠状动脉综合征（ACS）后接受CABG与PCI的患者出院时预防性药物治疗的使用率。
方法
在加拿大温哥华圣保罗医院进行了一项前瞻性队列研究。纳入2018年1月至11月期间出现ACS并接受CABG或PCI的≥18岁患者。收集预防性药物治疗使用情况及合理未使用原因（如不耐受、禁忌）的数据。
结果
共纳入275例患者。平均年龄65岁，83%为男性。总体而言，141例患者（51%）接受了CABG，134例患者（49%）接受了PCI。所有患者均接受了阿司匹林，但与PCI患者相比，接受CABG的患者中更多人服用325mg（vs 80 - 81mg）（25% vs 1%，P < 0.01）。接受PCI的患者（主要为替格瑞洛）使用P2Y12抑制剂的比例高于接受CABG的患者（主要为氯吡格雷）（99% vs 26%，P < 0.01）。所有接受CABG的患者均接受了β受体阻滞剂治疗，而接受PCI的患者中这一比例为96%（P = 0.017）。接受PCI的患者使用血管紧张素调节剂的比例更高（98% vs 65%，P < 0.01）。两组他汀类药物的使用情况相似（99% vs 99%，P = 0.96），但接受PCI的患者中更多人接受最大剂量治疗（89% vs 64%，P < 0.01）。
结论
无论血运重建策略如何，ACS后患者阿司匹林、β受体阻滞剂和他汀类药物的使用率都很高，而即使在调整合理未使用情况后，接受CABG的患者中P2Y12抑制剂和血管紧张素调节剂的使用仍不足。
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