JACC：冠脉搭桥术后药物二级预防少于PCI

　　美国一项比较行冠脉搭桥术（CABG）和经皮冠脉介入治疗（PCI）后循证二级预防药物治疗的研究显示，血运重建术后第一年，行CABG的患者进行循证二级预防药物治疗者似乎更少。该研究2012年12月12日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。

　　冠脉血运重建后心脏保护药物的使用情况相对不佳，且在各个研究中并不一致。研究者对一个大型综合医疗服务系统中因新发冠脉疾病行CABG或PCI的患者进行了调查，利用健康计划数据库分析初次冠脉血运重建治疗后第一年期间处方情况以鉴别从未填写处方的患者并计算填写处方患者的药物持有比，关注的药物为血管紧张素酶转换酶抑制剂（ACEI）、血管紧张素酶受体拮抗剂（ARB）、β受体阻滞剂和他汀。

　　在2000-2007年，有8837例新发冠心病患者行初次CABG，14516例患者行初次PCI。行CABG的患者较行PCI的患者更易不填写他汀处方（7.1%对4.8%，P<0.0001）及ACEI/ARB处方（29.1%对22.4%，P<0.0001），但未填写β受体阻滞剂的比例相似。在血运重建后1年至少填写了1次处方的患者中，行CABG的患者较行PCI者有更低的药物持有率：ACEI/ARB为69.4%对77.8%（P<0.0001）；β受体阻滞剂为76.1%对80.6%（P<0.0001）；他汀为82.7%对84.2%（P<0.001）。

Use of Medications for Secondary Prevention After Coronary Bypass Surgery Compared With Percutaneous Coronary Intervention ONLINE FIRST

Objectives  

We sought to compare use of evidence-based secondary preventive medications after coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI).

Background  

Use of cardioprotective medication after coronary revascularization has been inconsistent and relatively low in older studies.

Methods  

We studied patients in a large integrated healthcare delivery system who underwent CABG or PCI for new onset coronary disease. We used data from health plan databases about prescriptions dispensed during the first year after initial coronary revascularization to identify patients who never filled a prescription and to calculate the medication possession ratio among patients who filled at least 1 prescription. We focused on angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), beta-blockers, and statins.

Results  

Between 2000 and 2007, 8,837 patients with new onset coronary disease underwent initial CABG, and 14,516 underwent initial PCI. Patients receiving CABG were more likely than patients receiving PCI to not fill a prescription for a statin (7.1% vs. 4.8%, p < 0.0001) or for an ACEI/ARB (29.1% vs. 22.4%, p < 0.0001), but similar proportions never filled a prescription for a beta-blocker (6.4% vs. 6.1). Among those who filled at least 1 prescription post-revascularization, patients receiving CABG had lower medication possession ratios than patients receiving PCI for ACEI/ARBs (69.4% vs. 77.8%, p < 0.0001), beta-blockers (76.1% vs. 80.6%, p < 0.0001), and statins (82.7% vs. 84.2%, p < 0.001).

Conclusions  

Patients who received CABG were generally less likely than patients who received PCI to fill prescriptions for secondary preventive medications and to use those medications consistently in the first year after the procedure.