Survival of Patients with Acute Coronary Syndrome who Receive Secondary Prevention Therapy: A Single-center Cohort Study

接受次級預防治療之急性冠心症病患的生存分析－單中心世代研究

許青翎(Ching-Ling Hsu) ； 林郁珊(Yu-Shan Lin) ； 林維萱(Wei-Hsuan Lin) ； 郭俐纓(Li-Ying Kuo) ； 黃心怡(Hsin-Yi Huang)

《物理治療》 39卷4期 (2014/12) Pp. 223-230

https://doi.org/10.6215/FJPT.PTS1396504715

摘要

背景與目的：國際治療指引已建議急性冠心症病患應接受次級預防治療計畫，而其中生活型態治療是未被充分利用的。本研究為一單中心世代研究，目的在觀察理想的次級預防治療被使用的狀況，以及參與與否之生存率以及相關臨床特徵。方法：本研究收取2012年1月至2013年6月間因急性冠心症接受經皮冠狀動脈介入，並服用雙重抗血小板藥物治療之病患。定義接受雙重抗血小板藥物治療與生活型態治療（加入運動或飲食介入）為理想治療、僅接受雙重抗血小板藥物治療為次理想治療，並收集臨床事件、死亡、與病患特徵，利用Kaplan-Meier法與一般線性模式進行生存率與相關臨床資料分析，比較接受理想治療與次理想治療之情況。結果：有320位病患（80.2%）接受理想治療，此族群相較次理想治療者為年輕（63±13.3歲），男性較多（79.1%）。兩族群之臨床事件與死亡率（0.63% vs. 1.27%, p=0.359）沒有顯著差異。而理想治療中於出院後維持參與運動治療的比例相當低（17.8%）。結論：儘管理想治療與次理想治療之臨床事件與死亡率沒有顯著差異，仍發現生活型態治療是未被充分利用的。未來研究應著重急性冠心症病患中長期追蹤，強調出院後次級預防之治療順應性。

關鍵字

急性冠心症 ； 次級預防 ； 心臟復健

並列摘要

Background and Purpose: Secondary prevention for patients with acute coronary syndrome is recommended by international guidelines; however, lifestyle intervention is an underutilized component. The purpose of this study was to determine the use of optimal secondary prevention therapy in a single-center and to assess how the survival and characteristics of patients correlate with optimal therapy. Methods: We included patients with acute coronary syndrome who underwent percutaneous coronary intervention from January 2012 to June 2013. Patients received dual antiplatelet therapy during follow-up, and they were allocated to an optimal or a suboptimal therapy cohort. The optimal therapy cohort received additional diet or exercise therapy. Data for clinical events, death, and patients characteristics were collected, and Kaplan-Meier survival analysis and a general linear model were used to determine differences in outcomes between cohorts. Independent t and chi-square tests were used to analyze baseline characteristics. Results: Younger (63±13.3 years of age) men (n=253, 79.1%) populated the optimal therapy cohort (n=320, 80.2%). There was no significant difference in clinical events and mortality rates (0.63% vs. 1.27%, respectively, p=0.359) between cohorts. However, the rate of exercise therapy after discharge in the optimal therapy cohort was low (17.8%). Conclusions: Although we did not detect a significant difference in the rates of clinical events and mortality between cohorts, we believe that lifestyle intervention is insufficient. Further research should therefore focus on extended management after discharge to insure adherence to therapy.

並列關鍵字

Acute coronary syndrome ； Secondary prevention ； Cardiac rehabilitation