急性心肌梗塞患者的远期结果和治疗承诺:登记数据(哈巴罗夫斯克)

Илья Михайлович Давидович, Л. Н. Малай, Н. П. Кутишенко
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引用次数: 9

摘要

客观的评估参考急性心肌梗死(AMI)后2.5年患者的长期预后和药物治疗,研究药物治疗的依从性以及各种因素对长期预后的影响。材料和方法。AMI登记册包括所有患者的数据,这些患者在2014年1月1日至2014年3月31日期间一直在哈巴罗夫斯克地区血管中心(RVC)住院。通过电话访谈评估2.5年的疗效和对治疗的依从性。后果根据从区域血管中心(RVC)出院的292名AMI患者的前瞻性部分,2.5年内的生命状态确定为274人(93.8%),其中45人死亡(16.42%,或所有出院患者的15.40%)。在死亡率结构中,心血管疾病(СVD)患者的死亡比例为86.6%。ST段抬高心肌梗死患者的长期死亡率为19.3%,非ST段抬高的心肌梗死患者为13.2%;р=0.632。AMI发病2.5年后死亡的新预测因素是脑血管疾病,参考AMI前没有降压药和β-受体阻滞剂,在疾病早期没有开具负荷剂量的抗血小板药物。AMI后患者实际接受他汀类药物的频率为65.1%,血管紧张素-肾素阻断剂为76.0%,β-阻断剂为73.8%。在一年中,只有55.9%的患者接受了双重抗血栓细胞治疗(DATT)。通过Moriscors–Green测试,粘附者只有109人(47.6%)。79人(34.5%)知道他们的胆固醇、血压和血糖值。结论。在急性心肌梗死中ST段抬高的心肌梗死和急性心肌梗死非ST段抬高心肌梗死的患者中,远端致死率的指标没有真正的差异。记录的AMI失败预测因子显示,在参考AMI后的二级预防中,接受推荐药物的频率不足,尤其是他汀类药物和DATT。根据登记册,患者对长期药物治疗的承诺,以及对实际临床实践中治疗质量指标(胆固醇水平、血压)的认识都很低。
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ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ И ПРИВЕРЖЕННОСТЬ ТЕРАПИИ У ПАЦИЕНТОВ ПОСЛЕ ОСТРОГО ИНФАРКТА МИОКАРДА: ДАННЫЕ РЕГИСТРА (ХАБАРОВСК)
Objective . To evaluate the long-term outcomes and medical treatment in patients during 2.5 years after reference acute myocardial infarction (AMI), to study adherent to medical treatment and the role of various factors affecting the long-term prognosis. Materials and methods . The AMI Register included data about all patients, whom are consistently hospitalized in the regional vascular center (RVC) of Khabarovsk during the period from 01.01.14 till 31.03.14. The 2.5 years outcomes and adherence to treatment were evaluated by using phone interview. Results . According to prospective part of the AMI Register of 292 patients discharged from the regional vascular center (RVC), the vital status in 2.5 years managed to be established at 274 (93.8 %) from which died 45 (16.42 %, or 15.40 % from all discharged patients). In structure of a mortality the proportion of dead from cardiovascular disease (СVD) patients made 86.6 %. The long-term mortality of patients with myocardial infarction with ST-segment elevation was 19.3 %, the myocardial infarction non-ST-segment elevation – 13.2 %; р = 0.632. The new predictors of death 2.5 years after the onset of AMI were cerebrovascular diseases, the absence of the antihypertensive drugs and β-blockers before reference AMI, not prescribing antiplatelet drugs in loading doses in the early hours of the disease. Frequency of real reception of statins was 65.1 %, angiotensin-renin blockers –76.0  %, β-blocker – 73.8 % of patients after AMI. Only 55.9 % patients Received double antithrombocytic therapy (DATT)  during a year. By  the Moriscors–Green test adherent were only 109 (47.6 %). 79 (34.5 %) know their values cholesterol, blood pressure and blood glucose. Conclusions . Indicators of the remote lethality among patients authentically didn’t differ with a myocardial infarction with ST-segment elevation in AMI and a myocardial infarction non-ST-segment elevation in AMI in the remote period. The register AMI taped failure predictors, showed the insufficient frequency of reception of recommended medicinal drugs in secondary prophylaxis after a referent AMI, especially concerning statines and DATT.  The  commitment of patients of long medicamental therapy, and also awareness on indicators of quality of treatment (level of a cholesterin, blood pressure) in real clinical practice according to the register were low.
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