Hitomi Yasuhiro, Imai Yasushi, Kuwabara Masanari, Oba Yusuke, Kabutoya Tomoyuki, Kario Kazuomi, Makimoto Hisaki, Kohro Takahide, Shiraki Eiichi, Akashi Naoyuki, Fujita Hideo, Matoba Tetsuya, Miyamoto Yoshihiro, Kiyosue Arihiro, Tsujita Kenichi, Nakayama Masaharu, Nagai Ryozo
Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Japan.
Division of Public Health, Center for Community Medicine, Jichi Medical University, Japan.
Int J Cardiol Heart Vasc. 2024 Sep 12;54:101507. doi: 10.1016/j.ijcha.2024.101507. eCollection 2024 Oct.
Polypharmacy is associated with an increased risk of adverse events due to the higher number of drugs used. This is particularly notable in patients with chronic coronary syndrome (CCS), who are known to use a large number of drugs. Therefore, we investigated polypharmacy in patients with CCS, using CLIDAS, a multicenter database of patients who underwent percutaneous coronary intervention.
Between 2017 and 2020, 1411 CCS patients (71.5 ± 10.5 years old; 77.3 % male) were enrolled. The relationship between cardiovascular events occurring during the median follow-up of 514 days and the number of drugs at the time of PCI was investigated. The median number of drugs prescribed was nine. Major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke, heart failure, transient ischemic attack, or unstable angina, occurred in 123 patients, and all-cause mortality occurred in 68 patients. For each additional drug, the adjusted hazard ratios for MACE and all-cause mortality increased by 2.069 (p = 0.003) and 1.102 (p = 0.010). The adjusted hazard ratios for MACE and all-cause mortality were significantly higher in the group using nine or more drugs compared to the group using eight or fewer drugs (1.646 and 2.253, both p < 0.001).
This study showed that an increase in the number of drugs used for CCS may be associated with MACE and all-cause mortality. In patients with CCS, it might be beneficial to minimize the number of medications as much as possible, while managing comorbidities and using guideline-recommended drugs.
由于用药数量增多，多重用药与不良事件风险增加相关。这在慢性冠状动脉综合征（CCS）患者中尤为显著，已知这类患者使用大量药物。因此，我们利用CLIDAS（一个接受经皮冠状动脉介入治疗患者的多中心数据库）对CCS患者的多重用药情况进行了调查。
2017年至2020年期间，纳入了1411例CCS患者（年龄71.5±10.5岁；男性占77.3%）。研究了在514天的中位随访期内发生的心血管事件与PCI时用药数量之间的关系。所开药物的中位数为9种。123例患者发生了主要不良心血管事件（MACE，定义为心血管死亡、心肌梗死、中风、心力衰竭、短暂性脑缺血发作或不稳定型心绞痛），68例患者发生了全因死亡。每增加一种药物，MACE和全因死亡的调整后风险比分别增加2.069（p = 0.003）和1.102（p = 0.010）。与使用8种或更少药物的组相比，使用9种或更多药物的组中MACE和全因死亡的调整后风险比显著更高（分别为1.646和2.253，p均<0.001）。
本研究表明，用于CCS的药物数量增加可能与MACE和全因死亡相关。对于CCS患者，在管理合并症并使用指南推荐药物的同时，尽可能减少用药数量可能是有益的。
