Pietrzykowski Łukasz, Kasprzak Michał, Michalski Piotr, Kosobucka Agata, Fabiszak Tomasz, Kubica Aldona
Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland.
Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland.
J Clin Med. 2020 Dec 19;9(12):4109. doi: 10.3390/jcm9124109.
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients.
The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data.
Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42-18.65; = 0.013) and prior MI (OR 5.02; 95% CI 1.45-16.89; = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)-1.59; 95% CI 1.15-2.19; = 0.0049) and prior revascularization (HR-1.44; 95% CI 1.04-2.19; = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications.
The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
心肌梗死后停止推荐治疗会使患者易发生严重血栓并发症。本研究的目的是全面分析药物治疗的永久以及短期和长期中断情况，同时考虑心肌梗死后（MI）患者一年随访期间的基本药物类别和不依从性决定因素。
本研究为单中心队列临床试验，随访一年，纳入225例患者（男性73.3%，女性26.7%），年龄62.9±11.9岁。8例（3.6%）患者因过早死亡随访时间不足一年。分析了以下因素：出院后未开始治疗；短期治疗中断（<30天）；长期治疗中断（≥30天）；以及永久停止治疗。基于处方配药数据进行治疗中断分析。
职业活动（优势比（OR）5.15；95%置信区间（CI）1.42 - 18.65；P = 0.013）和既往心肌梗死（OR 5.02；95% CI 1.45 - 16.89；P = 0.009）被发现是出院后未开始使用P2Y受体抑制剂治疗的独立预测因素。我们未发现单独或联合分析时其他药物出院后未开始治疗的独立预测因素。65岁以上年龄（风险比（HR） - 1.59；95% CI 1.15 - 2.19；P = 0.0049）和既往血管重建术（HR - 1.44；95% CI 1.04 - 2.19；P = 0.0273）被确定为治疗中断的独立预测因素。多因素逻辑回归分析未显示任何药物停止使用以及所有药物永久或暂时同时停止使用的独立预测因素。
绝大多数心肌梗死后患者在心肌梗死后一年内会暂时或永久停止使用一种基本药物。最有可能停止使用的药物类别是他汀类药物。年龄较大和既往心脏血管重建术是治疗中断的独立决定因素。
