心肌梗死后伴或不伴阻塞性冠状动脉疾病患者对二级预防性治疗的依从性。
Adherence to secondary preventive treatment following myocardial infarction with and without obstructive coronary artery disease.
作者信息
Nordenskjöld Anna M, Qvarnström Miriam, Wettermark Björn, Lindahl Bertil
机构信息
Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden.
出版信息
PLoS One. 2025 May 23;20(5):e0324072. doi: 10.1371/journal.pone.0324072. eCollection 2025.
BACKGROUND
Secondary preventive medications following myocardial infarction (MI) reduce the risk of new cardiovascular events. Discontinuation and suboptimal adherence are common and affect prognosis. However, there is limited knowledge regarding adherence in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). We therefore aim to evaluate the adherence to guideline recommended medications in patients with MINOCA and myocardial infarction with obstructive coronary arteries (MI-CAD).
METHODS
This was a Swedish nationwide observational study of MI patients recorded in the SWEDEHEART registry between 2006─2017. A total of 9,138 MINOCA and 107,240 MI-CAD patients were followed for a mean 5.9 years. Initiation of therapy, implementation determined using medication possession ratio, and persistence rates during different time periods were calculated.
RESULTS
Patients with MINOCA were less frequently prescribed secondary preventive medications than MI-CAD. The percentage of patients taking medication as prescribed were lower in MINOCA than in MI-CAD at all time points; during months 6─12 after discharge: aspirin 94.8% vs 97.2% (p < 0.001), statins 90.3% vs 94.7% (p < 0.001), and ACEI/ARBs 97.7% vs 98.5% (p = 0.002) and at 12 months: aspirin 84.4% vs 93.7% (p < 0.001), statins 83.8% vs 94.8% (p < 0.001), ACEI/ARBs 85.0% vs 92.2% (p < 0.001) and beta blockers 80.4% vs 89.6% (p < 0.001).
CONCLUSION
The rates of initiation, implementation, and persistence of secondary preventive medications were high in both MINOCA and MI-CAD patients during the first 5 years after MI. The lower rates in patients with MINOCA may be partially due to uncertainties regarding the diagnosis of MINOCA, differences in patient characteristics, and psychosocial factors. Suboptimal medical adherence in patients with MINOCA may adversely affect prognosis as previously demonstrated in MI-CAD patients.
背景
心肌梗死（MI）后的二级预防药物可降低新发心血管事件的风险。药物停用和依从性欠佳情况常见，且会影响预后。然而，关于非阻塞性冠状动脉心肌梗死（MINOCA）患者的依从性，人们了解有限。因此，我们旨在评估MINOCA患者和阻塞性冠状动脉心肌梗死（MI-CAD）患者对指南推荐药物的依从性。
方法
这是一项针对2006年至2017年期间瑞典全国范围内在SWEDEHEART注册登记的MI患者的观察性研究。共对9138例MINOCA患者和107240例MI-CAD患者进行了平均5.9年的随访。计算不同时间段内的治疗起始率、使用药物持有率确定的实施率以及持续率。
结果
MINOCA患者接受二级预防药物治疗的频率低于MI-CAD患者。在所有时间点，MINOCA患者按处方服药的比例均低于MI-CAD患者；出院后6至12个月期间：阿司匹林分别为94.8%和97.2%（p<0.001），他汀类药物分别为90.3%和94.7%（p<0.001），ACEI/ARB分别为97.7%和98.5%（p=0.002）；在12个月时：阿司匹林分别为84.4%和93.7%（p<0.001），他汀类药物分别为83.8%和94.8%（p<0.001），ACEI/ARB分别为85.0%和92.2%（p<0.001），β受体阻滞剂分别为80.4%和89.6%（p<0.001）。
结论
MI后前5年，MINOCA和MI-CAD患者二级预防药物的起始率、实施率和持续率均较高。MINOCA患者的较低比率可能部分归因于MINOCA诊断的不确定性、患者特征差异和社会心理因素。正如先前在MI-CAD患者中所证明的那样，MINOCA患者的药物依从性欠佳可能会对预后产生不利影响。
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