摘要
目的分析稳定性冠心病患者应用替格瑞洛12个月的依从性、影响因素和对预后的影响。方法连续收集阜外医院2015年1月1日至6月30日住院期间和出院后继续服用替格瑞洛的稳定性冠心病患者,通过病历查阅、电话或门诊获得患者长期用药资料,并在出院后6个月和12个月进行随访。结果本研究共纳入155例高危稳定性冠心病患者(104例接受介入治疗),其中男性122例(78.7%),平均年龄(57.0±10.0)岁,既往心肌梗死50例(32.3%),左主干或多支病变106例(68.4%)。出院12个月内46例(29.7%)患者提前停服替格瑞洛,其中25例(54.3%)替换为氯吡格雷。发生出血事件和当地无药是提前停服替格瑞洛的主要原因。单因素分析显示,年龄、体重指数、高血压病和当地是否有药与提前停服替格瑞洛相关。多因素分析显示,患者年龄越大(OR 4.13,95%CI 1.40~12.19,P=0.012),依从性越差,而当地有药物(OR 0.25,95%CI 0.09~0.69,P=0.013)患者依从性好。但提前停服替格瑞洛并不增加不良心血管事件(心源性死亡、卒中、心肌梗死)的发生率(P=0.761)。结论稳定性冠心病患者出院后服用替格瑞洛依从性较差,年龄大与当地无药是依从性差的独立预测因子。尽管停服替格瑞洛,但并没有增加不良心血管事件发生率。
Objective Ticagrelor-related dyspnea may affect the medication adherence of patients with coronary artery disease. This study aims to assess the impact of ticagrelor adherence on 1-year cardiovascular outcomes in pateints with stable coronary artery diseases （SCAD）. Methods This study includes the patients with SCAD from Fuwai hospital who discharged with ticagrelor between Jan. 2015 to Jun. 2015 . We collected data of clinical characteristics and ticagrelor adherence from these patients by reviewing the electronic medical records and personnel interview. Follow-up was performed at 6 and 12 months by telephone interview or office visits. Results A total of 155 patients with SCAD were enrolled, of whom 122 （78.7%） were males with a mean age （57.0 -＋ 10.0） years. Among them, 50 （32.3%） patients have a history of myocardial infraction and 106 （68.4%） patients had angiographic confirmed left main and/or multivessel disease. Forty-six patients （ 29.7% ） with SCAD prematurely stopped ticagrelor within 12 months,while 25 （16.1%） patients switched from ticagrelor to clopidogrel. Hemorrhagic events and locally unavailable ticagrelor were the major reasons causes of the premature discontinuation of ticagrelor. Univariate analysis showed age, body mass index （BMI）, hypertention and locally unavailable ticagrelor as relative factors for early ticagrelor discontinuation after discharge. Multivariate analysis revealed unavailable drug locally （ OR 0. 25,95% CI 0. 09-0.69） and elderly patients （ OR 4. 13,95% CI 1.40- 12.19） were risk factors for low persientence or premature ticagrelor discontinuation. Conclusion This study showed poor ticagrelor adherence in patients with SCAD after discharge. Locally unavailable ticagrelor and elderly patients were strong predictors of poor ticagrelor adherence. Discontinuation to ticagrelor prematurely may not have impact on adverse cardiovascular outcomes.
出处
《中国介入心脏病学杂志》
2017年第6期301-306,共6页
Chinese Journal of Interventional Cardiology
关键词
替格瑞洛
稳定性冠心病
依从性
Ticagrelor
Stable coronary artery disease
Adherence
