The Compliance Of Secondary Prevention And The Prognosis In Patients With Coronary Heart Disease Post Percutaneous Coronary Intervention

Objective:To investigate the compliance status of secondary prevention in patients with coronary heart disease(CHD) post percutaneous coronary intervention(PCI).To discuss the relationship between the compliance status of secondary prevention(the target rate of risk factor control and the normalization of using secondary prevention drugs) and major adverse cardiac events (MACE). To emphasize the effectiveness and necessity of the secondary prevention strategy of CHD.Methods:A total of636patients with CHD who received procedures of PCI in the second hospital of Tianjin Medical University were enrolled in the study from December2011to December2012. The demographic information, the control of the modifiable risk factors, the angiographic and procedural features,the use of secondary prevention drugs were recorded.The risk factors of CHD include smoking,overweight,hypertension,diabetes mellitus,dyslipidemia. The secondary prevention drugs include aspirin(ASA),statins,β receptor blocker(BB),angiotension converting enzyme inhibitor(ACEI) or adrenergic receptor blockers(ARB).The control of the risk factors of CHD,the use of secondary prevention drugs and the occurrence of the MACE were recorded during the follow-up.The patients were followed up for a mean time of15.57±2.22months.The MACE include nonfatal myocardial infarction, target vessel revascularization(TVR), stent thrombosis(ST), angina recurrence,congestive heart disease, rehospitalization.Results:①The situation of risk factor control during hospitalization was as followed:among all the cases,64.94%of them with hypertension and58.96%achieved the level of blood pressure<140/90mmHg;68.71%of them with dyslipidemia and21.23%achieved the control standards;34.59%of them with diabetes mellitus and69.97%achieved the control standards;61.95%of them with overweight;50%of them with smoking.The prescription rates of ASA, statins, BB,ACEI/ARB were99.37%,97.79%,56.92%and68.87%respectively, the prescription rate of three drugs used at the same time was37.42%,the prescription rate of four drugs used at the same time was40.41%.②The situation of risk factor control during the follow-up was as followed: among all the cases, the proportions of achieving blood pressure targets was70.44%; the proportions of achieving serum lipid targets was42.14%, the proportions of achieving serum LDL-C targets was43.24%; the proportions of achieving serum sugar targets was75.79%; the proportions of achieving body mass index(BMI) targets was47.01%; the proportions of smoking was19.34%.Compared with the situation during hospitalization,the rates of patients achieving the control standards of risk factors was all significantly higher during the follow-up(P<0.05).The prescription rates of these drugs during follow-up were92.92%,78.77%,48.89%and43.55%,respectively,the prescription rate of three drugs used at the same time was34.12%,the prescription rate of four drugs used at the same time was20.44%, all significantly lower than those during hospitalization except the prescription rate of three drugs used at the same time (all P<0.05).③84patients happened to MACE and take a rate of13.21%during the follow-up.By the chi-square analysis, female,blood pressure control was not up to standard, serum sugar was not up to standard, smoking,irregular taking medicine had a significantly higher MACE occurrence rate(P<0.05).By the logistic regression analysis, blood pressure control was not up to standard, serum lipid serum control was not up to standard, serum sugar was not up to standard, smoking,irregular taking medicine are independent risk factors of MACE occurrence in patients with CHD after PCI.Conclusion:1.Compared with the situation during hospitalization,the rates of achieving the control standards of the risk factors was all significantly higher during the follow-up in patients with CHD after PCI,but not so satisfactory; The prescription rates of these secondary prevention drugs during follow-up were all significantly lower than those during hospitalization.Prompt and effective measures should be taken to enhance the manage of secondary prevention and compliance in patients with CHD after PCI,then minimize the gap between clinical practice and evidence-based guidelines.2.The patients with CHD after PCI who didn’t achieve the control standards of risk factors and didn’t take secondary prevention drugs regular may have a higher MACE occurrence.Therefore it is important to enhance the secondary prevention strategy for reducing the MACE occurrence and improving the prognosis in patients with CHD after PCI.