Variations in Use of Optimal Medical Therapy in Patients With Nonobstructive Coronary Artery Disease: A Population-Based Study.
Variations in Use of Optimal Medical Therapy in Patients With Nonobstructive Coronary Artery Disease: A Population-Based Study.
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DOI：
10.1161/jaha.117.007526
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发表时间：
2017-11-18
影响因子：
5.4
通讯作者：
Wijeysundera HC
中科院分区：
文献类型：
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作者：
Oxner A;Elbaz-Greener G;Qui F;Masih S;Zivkovic N;Alnasser S;Cheema AN;Wijeysundera HC
关于非阻塞性冠状动脉疾病是否需要最佳药物治疗（OMT）的数据很少。我们试图了解OMT在非阻塞性冠状动脉疾病患者中的使用在医院之间是否存在差异，与这种差异相关的因素及其临床后果。使用加拿大安大略的人群水平临床登记研究，我们确定了2010年11月1日至2013年10月31日期间因稳定型心绞痛适应症接受冠状动脉造影术的所有年龄>66岁且患有非阻塞性冠状动脉疾病的患者。分层多变量logistic模型被开发来识别与OMT使用相关的因素，中位比值比用于量化医院之间的变异程度，而不是由建模的风险因素解释。关注的临床结局为全因死亡和再住院，随访至2015年3月31日。我们的队列包括5413例患者，其中2554例（47.2%）在1年内接受OMT。各医院的OMT差异为2倍（30.4%-61.8%）。血管造影前药物使用充分解释了医院之间的差异（无效模型中的中位数比值比为1.21，全模型中的中位数比值比为1.03）。经风险调整的死亡率无差异（风险比，0.94; 95%置信区间，0.76-1.16）;然而，接受OMT的患者全因再入院的风险较低（风险比，0.89; 95%置信区间，0.84-0.95）。OMT在非阻塞性冠状动脉疾病患者中的使用存在很大差异，其主要驱动因素是基线药物使用的差异。
There is a paucity of data on the need for optimal medical therapy (OMT) in nonobstructive coronary artery disease . We sought to understand if there was variation in the use of OMT between hospitals for patients with nonobstructive coronary artery disease, the factors associated with such variation, and its clinical consequences. Using a population‐level clinical registry in Ontario, Canada, we identified all patients >66 years undergoing coronary angiography for the indication of stable angina, who had nonobstructive coronary artery disease between November 1, 2010, and October 31, 2013. Hierarchical multivariable logistic models were developed to identify the factors associated with OMT use, with median odds ratio used to quantify the degree of variation between hospitals not explained by the modeled risk factors. Clinical outcomes of interest were all‐cause mortality and rehospitalization, with follow‐up until March 31, 2015. Our cohort consisted of 5413 patients, of whom 2554 (47.2%) were receiving OMT within 1 year. There was a 2‐fold variation in OMT across hospitals (30.4%–61.8%). The variation between hospitals was fully explained by preangiography medication use (median odds ratio of 1.21 in the null model and 1.03 in the full model). There was no difference in risk‐adjusted mortality (hazard ratio, 0.94; 95% confidence interval, 0.76–1.16); however, patients receiving OMT had a lower risk of all‐cause hospital readmission (hazard ratio, 0.89; 95% confidence interval, 0.84–0.95). There is wide variation in the use of OMT in patients with nonobstructive coronary artery disease, the major driver of which is differences in baseline medication use.