Zhang J, Jing R, Liu J J, Di C Y, Lu Y J, Gao P, Wang Y J, Yang R F, Lin W H
Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin 300457, China.
Zhonghua Yi Xue Za Zhi. 2021 Apr 20;101(15):1064-1070. doi: 10.3760/cma.j.cn112137-20200804-02280.
To investigate the application status of optimal medical therapy (OMT) in patients with coronary heart disease after percutaneous coronary intervention (PCI) and its influence on the 1-year prognosis of patients after surgery. Data of 3 812 patients diagnosed with coronary heart disease by coronary angiography and successfully completed PCI in the Department of Cardiology, TEDA International Cardiovascular Hospital from October 2016 to September 2017 were prospectively collected. The OMT status and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospitalization and 1, 6, and 12 months after discharge were recorded. Patients were divided into OMT group (=1 299) and non-OMT group (=2 289) according to their adherence to OMT after PCI. Chi-square test was used to compare the differences of MACCE between groups, and to screen for significant differences and clinically significant variables between groups. Cox regression model was used to analyze the influencing factors of MACCE after PCI. Among 3 588 patients (224 cases lost to follow-up), 58.8% (2 110/3 588) used OMT during hospitalization after PCI, and 36.0% (1 293/3 588) still adhered to OMT after 12 months of follow-up. The utilization rates of OMT showed a decreasing trend, among which till the 12 month, β-blockers and ACEI/ARB showed the greatest decreasing degree, from 75.3%(2 701/3 588) and 75.1%(2 692/3 588) to 59.1%(2 122/3 588) and 53.0%(1 903/3 588). Pearson χ analysis showed that elderly patients, the number of amalgamative diseases, history of PCI, history of chronic myocardial infarction, history of chronic renal insufficiency, the lesion counts, lesion type, the Gensini score, adhere to the OMT and smoking during the follow-up were related to postoperative MACCE, the difference was statistically significant (0.05). Cox regression model showed that OMT adherence after PCI was an independent protective factor for postoperative MACCE events (=0.471,95%: 0.300-0.734, =0.001). The application of OMT after PCI was suboptimal, and the application rate decreased with the lengthening of the discharge time, among which the use of ACEI/ARB and β-blockers deserved more attention. Adherence to OMT after PCI was an independent protective factor, which could reduce the incidence of postoperative MACCE and improve the prognosis of patients.
探讨优化药物治疗（OMT）在经皮冠状动脉介入治疗（PCI）后冠心病患者中的应用现状及其对患者术后1年预后的影响。前瞻性收集2016年10月至2017年9月在泰达国际心血管病医院心内科经冠状动脉造影诊断为冠心病并成功完成PCI的3812例患者的数据。记录住院期间以及出院后1、6和12个月时的OMT情况和主要不良心血管脑血管事件（MACCE）的发生情况。根据PCI术后对OMT的依从性将患者分为OMT组（=1299）和非OMT组（=2289）。采用卡方检验比较组间MACCE的差异，筛选组间的显著差异和具有临床意义的变量。采用Cox回归模型分析PCI术后MACCE的影响因素。在3588例患者（224例失访）中，58.8%（2110/3588）在PCI术后住院期间使用OMT，随访12个月后仍有36.0%（1293/3588）坚持使用OMT。OMT的使用率呈下降趋势，其中到12个月时，β受体阻滞剂和ACEI/ARB下降幅度最大，从75.3%（2701/3588）和75.1%（2692/3588）降至59.1%（2122/3588）和53.0%（1903/3588）。Pearsonχ分析显示，老年患者、合并疾病数量、PCI史、慢性心肌梗死史、慢性肾功能不全史、病变支数、病变类型、Gensini评分、随访期间坚持OMT以及吸烟与术后MACCE相关，差异有统计学意义（P<0.05）。Cox回归模型显示，PCI术后坚持OMT是术后MACCE事件的独立保护因素（HR=0.471，95%CI：0.300-0.734，P=0.001）。PCI术后OMT应用欠佳，且应用率随出院时间延长而降低，其中ACEI/ARB和β受体阻滞剂的使用更值得关注。PCI术后坚持OMT是独立保护因素，可降低术后MACCE发生率，改善患者预后。
