冠状动脉介入术后优化药物治疗冠心病患者临床预后及其影响因素分析  

Analysis of clinical prognosis and influencing factors of optimal medical therapy for patients with coronary heart disease after percutaneous coronary intervention

作　　者：郝敬严 张健[1] 高鹏[1] 敬锐[1] 刘菁晶[1] 邸成业[1] 王雅洁[1] 卢宇杰[1] 林文华[1] Hao Jingyan;Zhang Jian;Gao Peng;Jing Rui;Liu Jingjing;Di Chengye;Wang Yajie;Lu Yujie;Lin Wenhua(TEDA International Cardiovascular Hospital,Tianjin 300070,China)

机构地区：[1]泰达国际心血管病医院心内一科,天津300457

出　　处：《中国综合临床》2021年第6期481-488,共8页Clinical Medicine of China

基　　金：天津市科技计划项目(16ZXMJSY00080)。

摘　　要：目的研究冠心病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后优化药物治疗(optimal medical therapy,OMT)的临床预后及影响OMT依从性的相关因素。方法采用前瞻性研究方法选取2016年10月至2017年9月于泰达国际心血管医院确诊为冠心病并且成功接受PCI的3818例患者,收集其住院期间和1年后的临床信息及OMT应用情况进行研究。根据出院1年后随访时是否坚持OMT分为OMT组和非OMT组,对高血压、糖尿病和高脂血症的不平衡基线数据进行倾向性评分匹配后,比较两组患者的人口学特征、冠状动脉血运重建史、冠状动脉病变情况、入院相关实验室检查、OMT各类药物使用等情况,采用Cox回归模型分析冠心病患者长期OMT与临床预后的关系,采用多因素二元Logistic回归方法分析影响远期OMT依从性的相关因素。结果将3818例冠心病患者进行倾向性评分匹配后共纳入2596例患者。其中男1609例,女987例;年龄(62.51±9.56)岁,1年后随访时坚持OMT的患者有1298例(50%),双联抗血小板药物治疗、他汀类降脂药物、β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用率分别为97.0%(2517/2596)、94.5%(2454/2596)、69.6%(1806/2596)和64.2%(1666/2596),尤以血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂类和β受体阻滞剂的下降幅度最大。Cox回归分析显示,调整其他因素后,与非OMT组相比,PCI术后坚持OMT的患者预后较好(HR=0.416,95%CI 0.270~0.641,P<0.001);合并陈旧性心肌梗死病史(HR=1.804,95%CI 1.070~3.041,P=0.027)、心功能不全(HR=2.074,95%CI 1.161~3.702,P=0.014)、冠状动脉多支病变(HR=2.211,95%CI 1.228~3.983,P=0.008)、BMI>24 kg/m2(HR=1.570,95%CI 1.037~2.377,P=0.033)的冠心病患者PCI术后预后较差。多因素二元Logistic回归示住院期间OMT是长期OMT服药依从性的强影响因素(OR=41.278,95%CI 29.961~56.871,P<0.001),拥有较高学历、职工医疗保险及有PCObjective To study the clinical prognosis and related factors affecting optimal medical therapy(OMT)compliance of patients with coronary artery disease(CAD)undergoing percutaneous coronary intervention(PCI).Methods A prospective study was conducted to select 3818 patients who were diagnosed with CAD and successfully underwent PCI in TEDA International Cardiovascular Hospital from October 2016 to September 2017.The clinical information and application of OMT during hospitalization and 1 year later were collected for research.The patients were divided into OMT group and non OMT group according to whether they adhered to OMT during follow-up one year after discharge.After comparing the imbalance baseline data of hypertension,diabetes and hyperlipidemia with propensity score,demographic characteristics,coronary revascularization history,CAD,laboratory related laboratory examinations,and the use of OMT drugs were compared between the two groups.Cox regression model was used to analyze the relationship between long-term OMT and clinical prognosis in patients with CAD.Multivariate binary logistic regression was used to analyze the related factors affecting long-term OMT compliance.Results A total of 3818 cases of CAD patients were matched by propensity score and 2596 patients were included in the study.There were 1609 males and 987 females.The age was(62.51±9.56)years old.One year later,1298 patients(50%)insisted on OMT,including dual antiplatelet therapy(DAPT),statins,β-blockers and ACEI/ARB were 97.0%(2517/2596),94.5%(2454/2596),69.6%(1806/2596)and 64.2%(1666/2596),especially angiotensin converting enzyme inhibitors/angiotensin receptor blockers andβReceptor blockers decreased the most.Cox regression analysis showed that after adjusting for other factors,compared with non-adherence to OMT group,OMT after PCI was associated with better prognosis(HR=0.416,95%CI 0.270-0.641,P<0.001).The prognosis of CAD patients with history of old myocardial infarction(HR=1.804,95%CI 1.070-3.041,P=0.027),cardiac insufficiency(HR=2.07

关 键 词：冠心病 经皮冠状动脉介入治疗 优化药物治疗 临床预后 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]