慢性冠状动脉综合征患者经皮冠状动脉介入治疗期间所用药物数量与不良事件之间的关系:CLIDAS数据库分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS IJC Heart and Vasculature Pub Date : 2024-09-12 DOI:10.1016/j.ijcha.2024.101507
Yasuhiro Hitomi , Yasushi Imai , Masanari Kuwabara , Yusuke Oba , Tomoyuki Kabutoya , Kazuomi Kario , Hisaki Makimoto , Takahide Kohro , Eiichi Shiraki , Naoyuki Akashi , Hideo Fujita , Tetsuya Matoba , Yoshihiro Miyamoto , Arihiro Kiyosue , Kenichi Tsujita , Masaharu Nakayama , Ryozo Nagai , CLIDAS research group
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引用次数: 0

摘要

背景由于使用的药物较多,多药治疗会增加不良事件的风险。这一点在慢性冠状动脉综合征(CCS)患者中尤为明显,众所周知,这些患者会使用大量药物。因此,我们利用经皮冠状动脉介入治疗患者的多中心数据库CLIDAS,对慢性冠状动脉综合征患者的多药使用情况进行了调查。调查了中位随访 514 天期间发生的心血管事件与 PCI 时药物数量之间的关系。处方药物的中位数为 9 种。123名患者发生了主要心血管不良事件(MACE),即心血管死亡、心肌梗死、中风、心力衰竭、短暂性脑缺血发作或不稳定型心绞痛,68名患者全因死亡。每增加一种药物,MACE 和全因死亡率的调整危险比分别增加 2.069(p = 0.003)和 1.102(p = 0.010)。与使用 8 种或更少的药物组相比,使用 9 种或更多药物组的 MACE 和全因死亡率调整后危险比明显更高(1.646 和 2.253,均为 p <0.001)。对于慢性心肌梗死患者,在控制合并症和使用指南推荐药物的同时,尽可能减少用药数量可能是有益的。
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Relationship between the number of drugs used during percutaneous coronary intervention and adverse events in patients with chronic coronary syndrome: Analysis of CLIDAS database

Background

Polypharmacy is associated with an increased risk of adverse events due to the higher number of drugs used. This is particularly notable in patients with chronic coronary syndrome (CCS), who are known to use a large number of drugs. Therefore, we investigated polypharmacy in patients with CCS, using CLIDAS, a multicenter database of patients who underwent percutaneous coronary intervention.

Method and results

Between 2017 and 2020, 1411 CCS patients (71.5 ± 10.5 years old; 77.3 % male) were enrolled. The relationship between cardiovascular events occurring during the median follow-up of 514 days and the number of drugs at the time of PCI was investigated. The median number of drugs prescribed was nine. Major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke, heart failure, transient ischemic attack, or unstable angina, occurred in 123 patients, and all-cause mortality occurred in 68 patients. For each additional drug, the adjusted hazard ratios for MACE and all-cause mortality increased by 2.069 (p = 0.003) and 1.102 (p = 0.010). The adjusted hazard ratios for MACE and all-cause mortality were significantly higher in the group using nine or more drugs compared to the group using eight or fewer drugs (1.646 and 2.253, both p < 0.001).

Conclusion

This study showed that an increase in the number of drugs used for CCS may be associated with MACE and all-cause mortality. In patients with CCS, it might be beneficial to minimize the number of medications as much as possible, while managing comorbidities and using guideline-recommended drugs.

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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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