急性冠状动脉综合征患者中肾素-血管紧张素系统抑制剂的处方趋势与死亡率：来自马来西亚国家心血管疾病注册中心的见解
Prescribing Trends of Renin-Angiotensin System Inhibitors and Mortality among Acute Coronary Syndrome Patients: Insights from the Malaysian National Cardiovascular Disease Registry.
作者信息
Suki Siti Zaleha, Zuhdi Ahmad Syadi Mahmood, Yahya Abqariyah, Adnan Wan Ahmad Hafiz Wan Md, Zaharan Nur Lisa
机构信息
Department of Pharmacology, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia.
Centre of Preclinical Science Studies, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia.
出版信息
Saudi J Med Med Sci. 2024 Apr-Jun;12(2):145-152. doi: 10.4103/sjmms.sjmms_422_23. Epub 2024 Apr 5.
BACKGROUND
Despite guideline recommendations, suboptimal prescription rates of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been observed in patients with acute coronary syndrome.
OBJECTIVE
This study aimed to examine the temporal trends, variations, and mortality outcomes among acute coronary syndrome patients prescribed ACEIs/ARBs in the multi-ethnic population of Malaysia.
METHODOLOGY
This retrospective study utilized data from the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome registry, encompassing consecutive patient records from 2008 to 2017 ( = 60,854). Ten-year temporal trends of on-discharge ACEIs/ARBs prescription were examined. Demographics, clinical characteristics and 1-year all-cause mortality outcomes were compared between patients prescribed and not prescribed ACEIs/ARBs.
RESULTS
The 10-year prescription rate of on-discharge ACEIs/ARBs was 52.8% ( = 32,140), with a significant decline over the years [linear trend test, = 0.008; SD = 0.03; SE = 0.001; 95% CI = 0.55-0.64]. Patients aged ≥65 years (aOR = 0.79; 95% CI = 0.73-0.86) were less likely to be prescribed ACEIs/ARBs than those aged <65 years. In addition, patients with comorbid diabetes mellitus (DM) (aOR = 0.85; 95% CI = 0.79-0.92) and chronic kidney disease (CKD) (aOR = 0.34; 95% CI = 0.30-0.40) were significantly less likely to receive ACEIs/ARBs. IPW-adjusted survival analysis revealed a 38% lower 1-year all-cause mortality rate in patients prescribed on-discharge ACEIs/ARBs (HR = 0.62; 95% CI = 0.56-0.69; < 0.001).
CONCLUSION
Acute coronary syndrome patients with concomitant DM and CKD were less likely to receive on-discharge ACEIs/ARBs in Malaysia. Suboptimal prescription rates of ACEIs/ARBs persisted over the 10-year period, despite improved 1-year survival in ACS patients prescribed ACEIs/ARBs.
背景
尽管有指南推荐，但急性冠脉综合征患者中血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）的处方率仍未达到最佳水平。
目的
本研究旨在调查马来西亚多民族人群中，开具ACEIs/ARBs的急性冠脉综合征患者的时间趋势、差异及死亡率结局。
方法
这项回顾性研究利用了马来西亚国家心血管疾病-急性冠脉综合征登记处的数据，涵盖了2008年至2017年的连续患者记录（n = 60,854）。研究了出院时ACEIs/ARBs处方的十年时间趋势。比较了开具和未开具ACEIs/ARBs的患者的人口统计学、临床特征和1年全因死亡率结局。
结果
出院时ACEIs/ARBs的十年处方率为52.8%（n = 32,140），多年来呈显著下降趋势[线性趋势检验，P = 0.008；标准差 = 0.03；标准误 = 0.001；95%置信区间 = 0.55 - 0.64]。年龄≥65岁的患者（校正后比值比 = 0.79；95%置信区间 = 0.73 - 0.86）比年龄<65岁的患者开具ACEIs/ARBs的可能性更小。此外，合并糖尿病（DM）（校正后比值比 = 0.85；95%置信区间 = 0.79 - 0.92）和慢性肾脏病（CKD）（校正后比值比 = 0.34；95%置信区间 = 0.30 - 0.40）的患者接受ACEIs/ARBs的可能性显著更低。逆概率加权调整后的生存分析显示，出院时开具ACEIs/ARBs的患者1年全因死亡率降低了38%（风险比 = 0.62；95%置信区间 = 0.56 - 0.69；P < 0.001）。
结论
在马来西亚，合并DM和CKD的急性冠脉综合征患者出院时接受ACEIs/ARBs的可能性较小。尽管开具ACEIs/ARBs的急性冠脉综合征患者1年生存率有所提高，但ACEIs/ARBs的处方率在十年期间仍未达到最佳水平。
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