Department of Cardiology Saint Joseph Hospital, France.
Unit of Cardiology, Karolinska Institutet and Karolinska University Hospital Solna, Sweden.
Eur J Prev Cardiol. 2021 May 8;28(4):432-445. doi: 10.1177/2047487320912491. Epub 2020 Mar 31.
International guidelines recommend pharmacotherapy combinations for chronic coronary syndromes (CCSs) but medical management remains suboptimal.
The CICD-LT registry is investigating short- and long-term outcomes and management in patients in European Society of Cardiology (ESC) member countries, in a longitudinal ESC EURObservational Research Programme aimed at improving CCS management.
Between 1 May 2015 and 31 July 2018, 9174 patients with previous ST-elevation myocardial infarction (STEMI), non-STEMI or coronary revascularisation, or other CCS, were recruited during a routine ambulatory visit or elective revascularisation procedure. Baseline clinical data were recorded and prescribed medications analysed at initial contact and discharge, and according to patient gender and age (<75 vs. ≥75 years).
Poorly controlled cardiovascular risk factors, including current smoking (18.5%), obesity (33.9%), diabetes (25.8%), raised low-density lipoprotein cholesterol (73.3%) and persistent hypertension (24.7%), were common across all cohorts. At ambulatory visit or admission, the guidelines-recommended combination of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, aspirin, statin and any antiplatelet agent was prescribed to 57.8% of patients with STEMI/NSTEMI. Differences in prescribing rates, including for combination therapies, were observed based on age and gender and persisted after adjustment for demographic factors.
Cardiovascular risk factors were common in contemporary CCS patients and secondary prevention prescribing was suboptimal. Patients aged ≥75 years and, to some extent, female patients were less likely to receive guidelines-recommended drug combinations than younger and male patients. One- and two-year follow-up will study prescribing changes and associations between baseline characteristics/prescribing and subsequent clinical outcomes.
国际指南建议对慢性冠状动脉综合征（CCS）采用药物联合治疗，但医学管理仍不尽人意。
CICD-LT 注册研究正在调查欧洲心脏病学会（ESC）成员国患者的短期和长期结局和管理情况，这是一项旨在改善 CCS 管理的 ESC 欧洲观察性研究计划的一部分。
在 2015 年 5 月 1 日至 2018 年 7 月 31 日期间，9174 例既往发生 ST 段抬高心肌梗死（STEMI）、非 ST 段抬高心肌梗死或冠状动脉血运重建术或其他 CCS 的患者在常规门诊就诊或择期血运重建术期间入组。记录基线临床数据，并在初次就诊和出院时分析处方药物，同时根据患者性别和年龄（<75 岁与≥75 岁）进行分析。
所有队列中常见的心血管危险因素控制不佳，包括当前吸烟（18.5%）、肥胖（33.9%）、糖尿病（25.8%）、升高的低密度脂蛋白胆固醇（73.3%）和持续高血压（24.7%）。在门诊就诊或入院时，指南推荐将血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂、阿司匹林、他汀类药物和任何抗血小板药物联合用于 57.8%的 STEMI/NSTEMI 患者。基于年龄和性别观察到处方率差异，包括联合治疗，并且在调整人口统计学因素后仍然存在。
在当代 CCS 患者中，心血管危险因素很常见，二级预防药物的使用并不理想。≥75 岁的患者，在一定程度上，女性患者比年轻和男性患者更不可能接受指南推荐的药物联合治疗。一年和两年的随访将研究处方变化以及基线特征/处方与随后临床结局之间的关系。
