The Investigation Of Drug Medication Adherence To Secondary Prevention And Analysis Of The Factors Affecting Prognosis After Prcutaneous Coronary Intervention In Patients With Coronary Heart Disease

Objective:This study is designed to investigate the conditions of drug therapy and risk factos both in the hospital and during the follow-up period after prcutaneous coronary intervention in patients with coronary heart disease and therapyed in the second hospital of Shanxi medical university during 2010-2013.Analysis the correlation between major adverse cardiac cerebral events after discharged from hospital and medication compliance,risk factors,coronary artery lesion counts and placing stents number in coronary artery of these patients,in order to provide basis for further strengthen the secondary prevention,forecasting and improving the prognosis.Materials and methods:Selection 480 cases of CHD patients continuous line successful PCI therapy in the second hospital of shanxi medical university in January 2010- January 2013.Each patient were followed up for two years and registered the general information,the related risk factors,coronary artery lesion counts,placing stents number in coronary artery,drug treatment and its influence factors both hospitalization and follow-up period,follow-up and outcome.All the data were entered the database of CHD patients,Statistical the drug medication adherence of secondary prevention and MACCE happening of different times in CHD patients.The influence of related factors on the patients medication compliance was analysised by multivariate Logistic regression analysis,Survival curve drawed by Kaplan-meier method,and using the log-rank test univariate analysised the influencing factors of incidence of MACCE,many factors impact on patient survival time using survival analysis(COX regression) model.Results:1. Secondary prevention drug treatment:the 480 cases of PCI postoperative CHD patients during hospitalization use of aspirin,clopidogrel,β blockers,angiotensin converting enzyme inhibitor/angiotensin receptor antagonist(ACEI/ARB) and statins,were96.0%,99.8%,85.8%,58.9% and 99.2%;With the extension of discharge time,the drug utilization all showed a trend of gradual decline,followed up for 12 months fell to83.2%,83.4%,67.5%,83.4% and 67.5%;At the end of the two years follow-up further dropped to 78.2%,30.5%,58.6%,30.5% and 52.1%;Two years of decline rate were23.9%,71.4%,36.2%,51.9% and 50.8%,especially for the biggest drop in ACEI/ARB drugs;Which adhere to the dual antiplatelet therapy(DAPT) patients with more than one year of 81.9%;Patients which stick to the four drugs used in combination with for two years of 19.8%.2. The influence factors of medication adherence analysis:the Logistic stepwise regression analysis results show that the influence of PCI two years postoperative CHD patients quadruple drug medication adherence factors are age,marriage,culture degree,payment method,follow-up and complicating disease.3. MACCE occurred during follow-up:follow-up of 480 patients with 132 cases(27.5%) got at the end point of adverse events,including cardiac death 10 cases(2.1%),non cardiac death 3 cases(0.6%),unstable angina 53 cases(11.0%),14 cases(2.9%) of congestive heart failure,nonfatal myocardial infarction 14 cases(2.9%),15 cases(3.1%) of severe arrhythmia,once again reascularization 18 cases(3.8%),5 cases(1.1%) of cerebral apoplexy.4. Affect the risk of MACCE in PCI postoperative patients with CHD single factor analysis:age,smoking,body mass index(BMI),follow-up heart rate,hypertension,diabetes mellitus(DM),hyperlipidemia,coronary artery lesion counts and placing stents can elevated MACCE incidence,shorten the time to live;But one year of DAPT adherence and two years quadruple medication adherence can reduce the incidence of MACCE,prolong the survival time,and the difference is statistically significant.5. Affect the risk of MACCE in PCI postoperative patients with CHD multiple factors analysis:age,smoking,BMI,follow-up the heart rate,hypertension,DM,hyperlipidemia,coronary artery lesion counts and placing stents are risk factors for recurrence MACCE;but one year of DAPT adherence and two years quadruple medication adherence are protection factors for recurrence MACCE.Conclusions:1. One year of DAPT adherence overall good in PCI postoperative patients with CHD,but long-term medication adherence to secondary prevention drugs is poor;Combination less adherence;And with the passage of time,the adherence to gradually decline.Age,marriage,culture degree,payment method,follow-up situation and complicating diseases can affect patients’ medication compliance.2. Recurrence MACCE is a high probability event for PCI postoperative patients with CHD, in which the majority with unstable angina recurrence.3. One year of DAPT adherence and regular secondary prevention therapy are protection factors for recurrence MACCE;But some risk factors(age,smoking,BMI,follow-up heart rate,hypertension,DM,hyperlipidemia,coronary artery lesion counts and placing stents)have independent predictive value for recurrence of MACCE.The related risk factors should be controled and the medication compliance should be improved actively to improve the prognosis.