摘要
目的了解经皮冠状动脉介入治疗（PCI）术后患者对二级预防的依从性及其与长期临床预后的关系。方法对589例PCI术后患者进行药物治疗、吸烟状况及主要心脏不良事件（MACE）的随访。调查的药物包括阿司匹林、氯吡格雷、血管紧张素酶转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）、他汀类药物、B受体阻滞剂、钙通道拮抗剂（CCB）及硝酸酯类6类药物。对术后停药组、未停药组、吸烟组、未吸烟组心脏不良事件的发生率进行对比分析。结果平均随访时间18．92月，术后99．83％的患者使用氯吡格雷，应用时间为（7．89±4．96）月；阿司匹林、ACEI/ARB、B受体阻滞剂、他汀类药物、CCB及硝酸酯的应用率分别为98．98％、41．94％、63．50％、83．02％、19．69％及46．52％，随访时降到94．4％、35、99％、55．86％、65．87％、17．49％及35．31％；有31例（5．26％）患者完全停止抗血小板治疗；19例（3．23％）停用所有的药物。术前吸烟率为54、16％，随访时为17．83％。停药组和术后吸烟组增加非致死性心肌梗死及MACE的发生率分别为9．68％、19．35％和4．76％、11．43％，与未停药组和戒烟组非致死性心肌梗死及MACE的发生率1．08％、6．45％和0．83％、6．20％比较，差异均有统计学意义（均P〈0．05）。结论冠心病患者在PCI术后对二级预防的依从性良好，但仍有待进一步提高。术后停止抗血小板治疗及继续吸烟者预后差。
Objective To investigate the compliance of secondary prevention and the relationship with the long-term outcomes in patients undergoing percutaneous coronary intervention （ PCI ） . Methods 589 patients undergoing PCI were followed-up, and factors including major adverse cardiac events （ MACE ） ） , smoking status and the usage of antiplatelet agents, angiotensin converting enzyme inhibitor （ ACEI ） / angiotensin Ⅱ receptor blocker （ARB） , statins, beta blocker, calcium channel blocker and nitrates were recorded. Results The average follow-up time was 18.92 months. At discharge, 588 patients （ 99.83% ） were prescribed clopidogrel for （ 7.89 ± 4.96 ） months ;there were 31 patients （5.26% ） who completely discontinued antiplatelet therapy during follow-up. At discharge, the prescription rate of aspirin, ACEI/ARB, beta blocker, statins, calcium channel blocker and nitrates was 98.98% ,411 94% , 63.50%, 83.02% , 19.69% and 46.52% respectively, whereas at follow-up, these were decreased to 94.4% ,35.99% ,55.86% ,65.89%, 17.49% and 35.31%. At follow-up,there were still 105 current smokers （ 17.83% ）. Complete cessation of antiplatelet therapy and current smoking were related to the increased risk of non-fatal myocmxtial infarct （9.68% v. s. 1.08 %, P 〈 0.01 ） ; smoking （ 4.76% v. s. 0.83 %, P 〈 0.01 ） and MACE（19.35% v.s.6.45% ,P〈0.01） ;smoking （11.43% v.s. 6.20% ,P〈0.05）. Conclusion Most patients can adhere to secondary prevention during follow-up, however, the compliance with secondary prevention should be improved further. Cessation of antiplatelet therapy and current smoking contribute to poor prognosis.
出处
《中国综合临床》
北大核心
2008年第6期550-553,共4页
Clinical Medicine of China
关键词
冠状动脉介入治疗
二级预防
依从性
长期预后
Percutaneous coronary intervention
Secondary prevention
Compliance
Long-term outcome
