The Impact of De-escalation of Antianginal Medications on Health Status After Percutaneous Coronary Intervention.
The Impact of De-escalation of Antianginal Medications on Health Status After Percutaneous Coronary Intervention.
复制标题
经皮冠状动脉介入治疗后抗心绞痛药物降级对健康状况的影响。
DOI：
10.1161/jaha.117.006405
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发表时间：
2017
影响因子：
5.4
通讯作者：
Arnold,SuzanneV
中科院分区：
文献类型：
--
作者：
Qintar,Mohammed;Towheed,Arooge;Tang,Fengming;Salisbury,AdamC;Ho,PMichael;Grantham,JAaron;Spertus,JohnA;Arnold,SuzanneV
背景抗心绞痛药物(AAM)在经皮冠状动脉介入治疗(PCI)后可以被认为不那么重要，在血运重建后可能会降级。我们检查了冠状动脉介入治疗后出院时AAM降低的频率及其与随访健康状况的关系。方法和结果在10个中心的冠状动脉介入治疗登记中，西雅图心绞痛问卷在介入治疗前和术后6个月进行评估。AAM降级的定义是出院时AAM比入院时少或绝对剂量减少25%。在2743例经皮冠状动脉介入治疗患者(70%为男性)中，299例(11%)、714例(26%)和1730例(63%)患者的AAM分别降低、升高和不变。AAM降级的患者在6个月时报告心绞痛的可能性更大，而AAM没有变化或升级的患者(34%对24%对21%；P<；0.001)。采用多变量模型研究AAM降级与健康状况的关系，这些多变量模型调整了冠状动脉介入治疗后心绞痛的预测风险、血运重建的完整性以及AAM降级×血运重建的完整性的交互作用。AAM降级与血运重建的完全性之间存在显著的交互作用(P<；0.001)，提示AAM降级与不完全血运重建患者的健康状况损害程度更大相关。在不完全血运重建的患者中，出院时AAM的降级与心绞痛风险增加43%(相对风险1.43；95%可信区间1.26-1.63)和心绞痛相关的健康状况在6个月后恶化相关。结论每10名患者中就有1例发生AAM降级，并与心绞痛风险增加和健康状况恶化有关，尤其是在不完全血运重建的患者。
BackgroundAntianginal medications (AAMs) can be perceived to be less important after percutaneous coronary intervention (PCI) and may be de‐escalated after revascularization. We examined the frequency of AAM de‐escalation at discharge post‐PCI and its association with follow‐up health status.Methods and ResultsIn a 10‐center PCI registry, the Seattle Angina Questionnaire was assessed before and 6 months post‐PCI. AAM de‐escalation was defined as fewer AAMs at discharge versus admission or >25% absolute dose decrease. Of 2743 PCI patients (70% male), AAM were de‐escalated, escalated, and unchanged in 299 (11%), 714 (26%), and 1730 (63%) patients, respectively. Patients whose AAM were de‐escalated were more likely to report angina at 6 months, compared with unchanged or escalated AAM (34% versus 24% versus 21%;P<0.001). The association of AAM de‐escalation with health status was examined using multivariable models adjusting for the predicted risk of post‐PCI angina, completeness of revascularization, and the interaction of AAM de‐escalation×completeness of revascularization. There was a significant interaction between AAM de‐escalation and completeness of revascularization (P<0.001), suggesting that AAM de‐escalation was associated with greater impairment of health status among patients with incomplete revascularization. In patients with incomplete revascularization, de‐escalation of AAM at discharge was associated with 43% increased angina risk (relative risk, 1.43; 95% confidence interval, 1.26–1.63) and worse angina‐related health status at 6 months post‐PCI.ConclusionsDe‐escalation of AAM occurs in 1 in 10 patients post‐PCI, and it is associated with an increased risk of angina and worse health status, particularly among those with incomplete revascularization.