| Objective: To analysis retrospectively of patients who were first diagnosed with acute myocardial infarction(AMI)and successfully received percutaneous coronary intervention(PCI)treatment,taking aspirin enteric-coated tablets(100mg~*30 tablets,worship Pharmaceutical Healthcare Co.,Ltd.,approval number: J20130078,hereinafter referred to as aspirin),To investigate the factors why the patient's have poor aspirin compliance and the association with recurrence of major adverse cardiovascular events(MACE).Methods:(1)In a provincial-level third-grade class-A hospital in North Guangxi,we select patients who were newly diagnosed with acute myocardial infarction and successfully treated with PCI as the research subjects from January 1,2016 to July 31,2018,and patients who met the selection criteria were followed up.If MACE occurred during the follow-up period,the follow-up was terminated and the time of the first occurrence of MACE was recorded.If the MACE does not occur,the follow-up time was up to 31 December 2019.(2)During the follow-up period,the patients were observed to take aspirin enteric-coated tablets,and whether there was any recurrence of MACE.Observation indicators of the follow-up subjects include:(1)Basic information: gender,age,education,occupation,marital status,ethnicity,height,weight,and area of residence,etc.(2)Previous history of hypertension,diabetes,hyperlipidemia,smoking,renal insufficiency,etc.,family history of cardiovascular disease;(3)Date of admission,type of acute myocardial infarction,admission of Killip classification,complications of myocardial infarction,date of PCI,coronary artery disease,first aspirin Enteric-coated tablets date,length of hospital stay,discharge status,follow-up details of patients taking aspirin entericcoated tablets outside the hospital,statin use,other antiplatelet drugs ticagrelor and clopidogrel;(4)Because of major cardiovascular adverse events,patients were admitted to hospital again.(3)Based on the above baseline data,SPSS 21.0 was used for statistical analysis to study the correlation between each variable and the occurrence of major adverse cardiovascular events.Results:(1)A total of 471 questionnaires and 352 valid questionnaires were issued for this performance.The effective rate was 75%.The follow-up ended on December 31,2019.The longest follow-up time was 48 months,the shortest was 8 months,and the median followup time was 23 months.The age of the patients was 50-71 years(60.80 ± 10.52).There were 282 cases(80.1%),70 cases were female(19.9%),non-adherence to aspirin were 77 cases(21.9%)and 275 cases(78.1%)were continuously taking aspirin.(2)Comparing the baseline data of patients in the follow-up group and the lost group suggests that except for ethnicity,body mass index distribution,and hyperlipidemia distribution are difference(P<0.05),but the gender,age,education level,marital status,occupation,smoking history,high There were no statistically significant differences in blood pressure history,diabetes history,family history of cardiovascular disease,history of renal insufficiency,type of myocardial infarction,Coronary lesions,admission Killip classification,criminal blood vessel,complications,hospital stay were all no statistically differences(all P >0.05).(3)Distribution of MACE in the population and its influencing factors: A total of 94 cases(26.7%)occurred in the MACE group and 258 cases(73.3%)in the group without MACE.Among them,58 patients(61.7%)suffered from non-adherence to aspirin and 36 patients(38.3%)suffered from MACE.Among follow-up patients,the distribution of MACE was statistically different among the population with characteristics such as education level,marital status,history of diabetes,type of myocardial infarction,hospitalized Killip classification,poor compliance taking aspirin,and poor statin compliance(all P <0.05).Kaplan-meier method was used to draw the survival curve,and the results showed that there were significant differences in the survival curves of non-sustained use of aspirin,Killip classification,type of myocardial infarction,and discontinuation of statins.After controlling for confounding factors,the results of Cox multivariate regression analysis showed that Killip classification,non-adherence to aspirin treament,type of myocardial infarction,and discontinuation of statins were related to the occurrence of MACE.Among them,Killip classification was positively correlated with the occurrence of MACE.In addition,the risk of MACE in anterior STEMI is lower than that of non-ST-elevation myocardial infarction,and the risk of MACE in non-anterior STEMI and non-ST-elevation MI is not statistically different.Discontinued statins were 4 times more likely to develop MACE than those who were not discontinued.Those who did not take aspirin continuously were 7 times more likely to have MACE than those who were continuously taking them.(4)Influencing factors of non-sustained aspirin use: unmarried,divorced,widowed,and patients with low education level are associated with poor aspirin compliance.The main reason for stopping the drug is mainly gastrointestinal reaction,and the secondary reason is the improvement of conscious symptoms.Conclusion:(1)Non-sustained aspirin use is an independent factor affecting MACE.Non-sustained aspirin use may increase the risk of MACE.(2)For patients with indications for taking aspirin,if there are no drug contraindications,aspirin needs to be used for a long time.In practical clinical applications,there is still much room to further optimize aspirin treatment compliance,reduce the incidence of MACE,and improve Long-term prognosis.(3)Marriage and education are the influencing factors of non-sustained aspirin treatment. |
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