Investigation And Study On The Status Quo Of Secondary Prevention In Patients With Acute Coronary Syndrome After PCI In Qingdao

Objective:The purpose of this study is to investigate the situation of secondary prophylactic drugs and risk factors in patients with acute coronary syndrome after PCI in Qingdao,to understand the current situation of secondary prophylactic drugs for coronary heart disease and the control situation of risk factors,and to explore the effect and deficiency of standardized treatment for secondary prevention of coronary heart disease.Methods:A total of 567 patients admitted for coronary intervention due to acute coronary syndrome during the period of 1 solstice,May 2016 and 31,February 2017 in 4 major grade a hospitals in Qingdao were selected for the study.Unexplained deaths during the follow-up period of 8 cases(1.4%)and lost to 31 cases(5.5%),complete with a total of528 cases,for visitors to follow-up rate was 93.1%,using retrospective study method,compare the patients discharged from hospital,in January,march,June and December when secondary prevention drug application and coronary heart disease risk factors control.Observation indexes: body weight,smoking and smoking cessation,blood pressure,blood glucose,blood lipid status,secondary drug use status and occurrence of MACE,etc.Results :(1)333 male patients(63.1%)were followed up.With coronary heart disease risk factors: overweight and obesity in 287 cases(54.5%),210 cases(39.8%)has a history of smoking,177 cases(33.5%)had diabetes,high blood pressure is 342 cases(64.7%),has a blood lipid was abnormal in 299(56.6%),and have a family history of 195 cases(36.9%),including single lesions in 182 cases(34.5%),double branch lesions in 232cases(43.9%),multivessel lesions in 114 cases(21.6%).(2)The rate of taking secondary prophylactic drugs such as aspirin,polivi/tegrello,statins,beta blockers,and ACEI/ARB was 98.0%,99.6%,98.5%,69.5%,and 85.6%,respectively,in patients who completed the follow-up.Among the 4 types of drugs,antiplatelet drugs had the highest utilization rate,and only 3 patients were not used due to active bleeding or active gastric ulcer in vivo.At 1 month after discharge,the rates of aspirin,polivi/tegrello,statin,beta blocker,ACEI/ARB and other secondary prophylactic drugs were 98.3%,99.6%,98.1%,74.2% and 81.6%,respectively.The rates of taking drugs at 3 months after discharge were 95.6%,94.9%,96.6%,68.9% and 71.5%,respectively.At 6 months after discharge,the rates of taking were 94.7%,93.2%,87.5%,61.8% and 68.4%,respectively.The rate of taking drugs at 12 months after discharge was91.3%,90.7%,83.7%,50.7% and 67.7%,respectively.In addition,the rate of taking three kinds of secondary prophylactic drugs at the same time was 89.4%,86.9%,80.2%,61.4% and 50.0% in discharge,January,march,June and December.The rate of taking 4drugs at the same time was 68.9%,64.5%,56.8%,35.2% and 30.6% at discharge,1month,3 months,6 months and 12 months.The statistical analysis showed that the rate of statin,beta blocker,ACEI/ARB,three drugs and four drugs decreased significantly with the extension of follow-up time,which was statistically different from that of hospitalization(P < 0.05).(3)To Qingdao A provincial level 3 armour hospital PCI 218 patients after acute coronary syndrome(acs),Qingdao three representative at the municipal level 3 armour hospital PCI postoperative acute coronary syndrome(acs)in 310 patients were divided into group A and group B respectively,the statistical analysis shows that in group A and group B: statins,beta blockers and ACEI/ARB class 3 kinds of drug taking rate decline is obvious in hospital discharge in June and December,and statistically significant(P <0.05),January at discharge and discharge of group A and group B of all kinds of drug taking rate disparity is not obvious,and there was no statistically significant difference;There was no significant difference between the two groups(P > 0.05)in the rate of administration of various drugs between group A and group B at 12 months after discharge,while there was A statistically significant difference in the rate of administration of statins,beta blockers,and ACEI/ARB drugs(P < 0.05).(4)Univariate analysis and comparison of the number of coronary artery lesions in the patients showed that the age of the patients with two-vessel disease and multi-vessel disease,the history of diabetes and the history of dyslipidemia were all higher than those with single-vessel disease,and the difference was statistically significant(P < 0.05).The proportion of smoking history and hypertension history in patients with multi-vessel disease was higher than that in patients with single-vessel disease,and the difference was statistically significant(P < 0.05).Different stenosis degree of the index,the rest there was no statistically significant difference(P > 0.05),and an orderly multiariable logistic regression analysis,age,body mass index,smoking history,history of hypertension,diabetes and dyslipidemia history into the regression model,age,smoking history,history and history of diabetes and dyslipidemia patients count independent related coronary artery lesions(P < 0.05).(5)During the follow-up period,the smoking cessation rate of patients decreased from 75.2% at 1 month after discharge to 39.0% at 12 months after discharge,and the body mass index compliance rate increased from 11.8% at 1 month after discharge,18.1% at 3 months after discharge,and 27.2% at 6 months after discharge to 39.0% at 12 months after discharge.Blood pressure 63.7% success rate by the hospital on January,march,59.6% 51.5% in June to 41.5% in December,discharge blood sugar success rate by hospital discharge low of 52.9% in January to march,between the top 64.1% of blood fat 35.4% success rate by the hospital on January,march,42.8% 35.8% in June to December discharge only 20.5%,the patients discharged from hospital on December data statistical analysis,to give up smoking,body weight,blood fat and blood pressure up to standard of the controllable risk factors for the success rate of the discharge 1 month is an obvious increase,The difference was statistically significant(P < 0.05).(6)MACE of the definition of a total of 82 patients occurred during the follow-up period(15.5%),by chi-square analysis: occurred MACE to continue smoking,blood sugar in patients not up to standard and blood fat falls below than patients who were not occurred MACE,and formal taking statins,formal taking ACEI/ARB,normal three kinds of drugs,normal four drugs less than patients who were not occurred MACE,differences were statistically significant(P < 0.05);Patients occurred MACE in normal antiplatelet drugs group,normal taking beta blockers,DaBiaoZhe DaBiaoZhe successfully quit smoking,weight,blood sugar,blood fat not DaBiaoZhe DaBiaoZhe,weight and blood pressure are not DaBiaoZhe incidence compared with MACE in patients,there were no statistically significant difference(P > 0.05).Conclusions:The medication of secondary prophylactic drugs in patients after PCI is standard during hospitalization,but with the extension of discharge time,the rate of taking secondary prophylactic drugs gradually decreases,and the non-standard use of secondary prophylactic drugs can increase the occurrence of MACE in patients.Patients with acute coronary syndrome after PCI have a low compliance rate of controllable risk factors,and failure of controllable risk factors can increase the occurrence of MACE in patients.There were differences in the rate of secondary prophylactic drugs for coronary heart disease in different hospitals in the same region.