中药汤剂联合标准治疗对急性冠脉综合征PCI术后影响的回顾性队列研究

Retrospective cohort study of the effect of Chinese herbal decoction combined with standard therapyin the treatment of acute coronary syndrome after percutaneous coronary intervention

关键词:  急性冠脉综合征  经皮冠状动脉介入  中药汤剂  再住院  回顾性队列研究

Key words:  acute coronary syndrome  percutaneous coronary intervention  Chinese herbal decoction  readmission  retrospective cohort study

摘要:

[目的] 探讨早期应用中药汤剂联合标准治疗对急性冠脉综合征（ACS）急诊经皮冠状动脉介入（PCI）术后患者再住院的影响，为PCI术后早期中医药干预提供循证依据。[方法] 采用真实世界回顾性队列研究，纳入2019年1月—2021年8月所有在天津中医药大学第二附属医院诊断为ACS并行急诊PCI治疗的患者，采集临床基本资料、冠状动脉造影及介入数据、术后治疗方案，随访观察截至2022年4月再住院情况。根据实际治疗策略的差异，将患者分为中药汤剂联合标准治疗组（暴露组）和标准治疗组（非暴露组），以全因再住院为主要疗效指标，以因心脏事件再住院、因卒中再住院、因消化道损伤再住院为次要疗效指标，构建Cox回归模型，综合分析两种治疗方案患者预后差异。[结果] 共纳入ACS急诊PCI治疗患者232例，其中暴露组126例（54.31%），非暴露组106例（45.69%），多因素Cox回归分析显示，调整潜在混杂因素后，与非暴露组相比，暴露组因心脏事件再住院风险降低59%[HR=0.41，95%CI（0.21，0.81），P<0.05]，两组在全因再住院、因卒中再住院、因消化道损伤再住院方面差异均无统计学意义（P>0.05）。[结论] ACS急诊PCI术后早期中药汤剂联合标准治疗显著减少患者因心脏事件再住院风险，且不增加因消化道损伤或卒中住院风险。

Abstract:

[Objective] To investigate the effect of earlier use Chinese herbal decoction combined with standard therapy on readmission of patients with acute coronary syndrome (ACS) after emergencypercutaneous coronary intervention (PCI),and to provide evidence-based basis for early intervention of traditional Chinese medicine after PCI.[Methods] A real world retrospective cohort study was adopted. All patients diagnosed with ACS and accepted emergency PCI in second teaching hospital of tianjin university of traditional Chinese medicine from January 2019 to August 2021 were included. Basic clinical data,coronary angiography and intervention data,as well as therapeutic schedule were collected readmission up to April 2022 was followed up. According to the difference of actual therapeutic schedule,patients were divided into standard therapy group (non-exposed group) and Chinese herbal decoction combined with standard therapy group (exposed group). All-cause readmission was taken as the primary efficacy indicator,then readmission for cardiac events, readmission for stroke and readmission for digestive tract injury were taken as the secondary efficacy indicators. The prognostic differences between two therapeutic schedules were comprehensively analyzed through Cox regression.[Results] A total of 232 patients with ACS after emergency PCI were selected,including 126 patients (54.31%) in exposed group and 106 patients (45.69%) in non-exposed group. Multivariate Cox regression analysis showed that,after adjusting for potential confounding factors,compared with non-exposed group,the risk of readmission for cardiac events in exposed group decreased by 59%[HR=0.41,95%CI(0.21,0.81),P<0.05]. There was no significant difference in all-cause readmission,readmission for stroke or readmission for digestive tract disease between the two groups (P>0.05).[Conclusion] Earlier use Chinese herbal decoction combined with standard therapyin patients with acute coronary syndrome after emergency PCI can reduce the risk of readmission for cardiac events significantly,without increasing the risk of readmission for digestive tract injury or stroke.