DEPARTMENT OF MILITARY THERAPY, UKRAINIAN MILITARY MEDICAL ACADEMY, KYIV, UKRAINE.
DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHYSIOLOGY, LABORATORY OF CENTRE FOR PRECLINICAL RESEARCH, MEDICAL UNIVERSITY OF WARSAW, WARSAW, POLAND.
Wiad Lek. 2022;75(3):563-569.
The aim: The present study aimed to evaluate the adherence to medications prior and within a two-year period after ST-segment elevation myocardial infarction (STEMI) and to estimate its impact on the average lifespan of patients after STEMI.
Materials and methods: 1,103 patients with STEMI were enrolled in the prospective Ukrainian STIMUL registry with 24-month follow-up. The relationship between adherence to medical treatment and average lifespan was evaluated.
Results: The majority of prior STEMI patients were characterized with high and very high cardiovascular risk. The rate of revascularization was 29.9% (21.5% pPCI, 8.4% fibrinolytic therapy). The main reason for the low level of pPCI was late hospitalization and the inaccessibility of pPCI. This contributed greatly to in-hospital mortality (11.3%). Adherence to all medications progressively decreased (p < 0.001) within 24 months after STEMI. Permanent use of acetylsalicylic acid (ASA) and statins during the two-year follow-up was associated with 7.0% of the mortalities, whereas non-adherence to medications was related to a 15% risk of death (OR 4.2; 95% CI 0.2-0.9; p < 0.05). The average life expectancy with regular use of ASA and statins within 24 months after STEMI was 62.3 ± 1.1 years (95% CI 60.1-64.4; p < 0.05) and 61.2 ± 0.9 years with non-regular use of ASA and statins (95% CI 59.4-62.9; p < 0.05).
Conclusions: Adherence to evidence-based medicines was low in the STIMUL population both prior and after STEMI. This worsened cardiovascular prognosis and reduced average lifespan by one year within the following two years after STEMI.
本研究旨在评估 ST 段抬高型心肌梗死（STEMI）前和两年内患者对药物的依从性，并估计其对 STEMI 后患者平均寿命的影响。
1103 例 STEMI 患者纳入前瞻性乌克兰 STIMUL 注册研究，随访 24 个月。评估了药物治疗依从性与平均寿命之间的关系。
大多数 STEMI 患者具有较高和极高的心血管风险。血管重建率为 29.9%（21.5%直接经皮冠状动脉介入治疗[pPCI]，8.4%溶栓治疗）。pPCI 水平较低的主要原因是住院时间晚和无法进行 pPCI。这导致住院死亡率较高（11.3%）。STEMI 后 24 个月内，所有药物的依从性均逐渐下降（p<0.001）。在两年的随访中，持续使用乙酰水杨酸（ASA）和他汀类药物与 7.0%的死亡率相关，而不遵医嘱与 15%的死亡风险相关（OR 4.2；95%CI 0.2-0.9；p<0.05）。STEMI 后 24 个月内定期使用 ASA 和他汀类药物可使预期平均寿命延长至 62.3±1.1 岁（95%CI 60.1-64.4；p<0.05），而非定期使用 ASA 和他汀类药物的预期平均寿命为 61.2±0.9 岁（95%CI 59.4-62.9；p<0.05）。
STIMUL 人群在 STEMI 前后均存在低水平的循证医学药物依从性。这导致心血管预后恶化，并使 STEMI 后两年内的平均预期寿命缩短了一年。
