墨西哥ST段抬高型心肌梗死患者对最佳药物治疗的依从性及心血管危险因素的控制
Adherence to optimal medical therapy and control of cardiovascular risk factors in patients after ST elevation myocardial infarction in Mexico.
作者信息
Villalobos-Pedroza Montserrat, Hernandez-Pastrana Sarai, Arias-Mendoza Alexandra, Latapi-Ruiz Esparza Ximena, Robles-Ledesma Mariana, Guerrero-Ochoa Alejandra, Milanes-Gonzalez Nelson Antonio, Solis-Jimenez Fabio, Sierra Gonzalez-De Cossio Alejandro, Flores-Batres Alejandro Pablo, Brindis-Aranda Arielle Astrid, Rivera-Pedrote Edgar, Jara-Nevarez Alejandra, Gonzalez-Macedo Eder, Gopar-Nieto Rodrigo, Gonzalez-Pacheco Héctor, Briseño-De la Cruz Jose Luis, Araiza-Garaygordobil Diego
机构信息
Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", México City, Mexico.
出版信息
Front Cardiovasc Med. 2024 Jul 23;11:1384684. doi: 10.3389/fcvm.2024.1384684. eCollection 2024.
INTRODUCTION
In developing countries, there is a notable scarcity of real-world data on adherence to optimal medical therapy (OMT) and its correlation with major cardiovascular adverse events (MACEs) after ST-elevation myocardial infarction (STEMI). Our study focuses on addressing this gap by evaluating adherence to OMT, examining its influence on the risk of MACEs after STEMI, and assessing subsequent cardiovascular risk factor control in Mexico.
METHODS
We conducted a prospective observational study of post-STEMI patients after hospital discharge. Adherence to treatment was assessed over a median of 683 days (interquartile range: 478-833) using the Simplified Medication Adherence Questionnaire (SMAQ). Patients were followed up for 4.5 years to monitor MACEs (cardiovascular death, cardiogenic shock, recurrent myocardial infarction, and heart failure).
RESULTS
We included 349 patients with a mean age of 58.08 years (±10.9), predominantly male (89.9%). Hypertension (42.4%), smoking (34.3%), type 2 diabetes mellitus (31.2%), obesity (22.92%), and dyslipidemia (21.4%) were highly prevalent. Adherence to OMT per SMAQ was 44.7%. The baseline clinical characteristics of adherent and non-adherent patients did not significantly differ. OMT prescription rates were as follows: acetylsalicylic acid, 91.1%; P2Y12 inhibitors, 76.5%; and high-intensity statins, 86.6%. While non-adherent patients had a numerically higher rate of MACEs (73 vs. 49 first events), there was no statistically significant difference (hazard ratio 1.30, 95% confidence interval 0.90-1.88).
DISCUSSION
In this real-world study of patients after STEMI, we observed low adherence to OMT, a low proportion of global cardiovascular risk factor control, and a numerically higher incidence of recurrent major adverse cardiovascular events in non-adherent patients. Strategies to improve adherence to OMT and risk factor control are needed.
引言
在发展中国家，关于ST段抬高型心肌梗死（STEMI）后最佳药物治疗（OMT）的依从性及其与主要心血管不良事件（MACEs）相关性的真实世界数据明显匮乏。我们的研究旨在通过评估OMT的依从性、研究其对STEMI后MACEs风险的影响以及评估墨西哥随后的心血管危险因素控制情况来填补这一空白。
方法
我们对STEMI患者出院后进行了一项前瞻性观察性研究。使用简化药物依从性问卷（SMAQ）在中位时间683天（四分位间距：478 - 833天）内评估治疗依从性。对患者进行4.5年的随访以监测MACEs（心血管死亡、心源性休克、再发心肌梗死和心力衰竭）。
结果
我们纳入了349例患者，平均年龄为58.08岁（±10.9），男性占主导（89.9%）。高血压（42.4%）、吸烟（34.3%）、2型糖尿病（31.2%）、肥胖（22.92%）和血脂异常（21.4%）非常普遍。根据SMAQ，OMT的依从率为44.7%。依从和不依从患者的基线临床特征无显著差异。OMT的处方率如下：阿司匹林，91.1%；P2Y12抑制剂，76.5%；高强度他汀类药物，86.6%。虽然不依从患者的MACEs发生率在数值上较高（首次事件分别为73例和49例），但无统计学显著差异（风险比1.30，95%置信区间0.90 - 1.88）。
讨论
在这项针对STEMI后患者的真实世界研究中，我们观察到OMT依从性低、全球心血管危险因素控制比例低，且不依从患者中复发性主要不良心血管事件的发生率在数值上较高。需要采取策略来提高OMT的依从性和危险因素控制。
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