Cargando…
Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study
The purpose of this study was to discuss the present situation of discharge medications in coronary artery disease (CAD) patients with different levels of renal function and assess the potential impact of these medications on the prognosis of this patient population. A retrospective cohort study was...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753913/ https://www.ncbi.nlm.nih.gov/pubmed/26871817 http://dx.doi.org/10.1097/MD.0000000000002740 |
_version_ | 1782415938436464640 |
---|---|
author | Peng, Yong Xia, Tian-li Huang, Fang-yang Huang, Bao-tao Liu, Wei Chai, Hua Zhao, Zhen-gang Zhang, Chen Liao, Yan-biao Pu, Xiao-bo Chen, Shi-jian Li, Qiao Xu, Yuan-ning Luo, Yang Chen, Mao Huang, De-jia |
author_facet | Peng, Yong Xia, Tian-li Huang, Fang-yang Huang, Bao-tao Liu, Wei Chai, Hua Zhao, Zhen-gang Zhang, Chen Liao, Yan-biao Pu, Xiao-bo Chen, Shi-jian Li, Qiao Xu, Yuan-ning Luo, Yang Chen, Mao Huang, De-jia |
author_sort | Peng, Yong |
collection | PubMed |
description | The purpose of this study was to discuss the present situation of discharge medications in coronary artery disease (CAD) patients with different levels of renal function and assess the potential impact of these medications on the prognosis of this patient population. A retrospective cohort study was conducted. From July 2008 to Jan 2012, consecutive patients with CAD confirmed by coronary angiography of West China Hospital were enrolled and were grouped into 3 estimated glomerular filtration rate (eGFR) categories: ≥60, 30 to 60, and <30 mL/min/1.73 m(2). The endpoints were all-cause mortality and cardiac mortality. There are 3002 patients according to the inclusion criteria and follow-up requirement. The mean follow-up time was 29.1 ± 12.5 months. CAD patients with worse renal function included more cardiovascular risk factors (advanced age, history of hypertension or diabetes, and diagnosis of acute myocardial infarction). The cumulative survival curves of the patients according to renal function showed that the eGFR <30 mL/min and 30 mL/min ≤ eGFR <60 mL/min groups had a significantly higher risk of all-cause death and cardiovascular death than the group with an eGFR ≥60 mL/min. The prescription of evidence-based medicines (EBMs) at discharge (antiplatelet agents, beta-blockers, statins, and angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin-receptor blockers [ARBs]) was a factor in reducing the risk of all-cause death and cardiovascular death. However, EBMs prescribed at discharge revealed an obvious underuse in renal insufficiency (RI) patients. The results of Cox regression showed that irrespective of the eGFR level, greater use of EBMs resulted in a greater reduction in the risk of all-cause death and cardiovascular death. A higher percentage of patients with CAD and concomitant RI suffered from cardiovascular disease (CVD) risk factors, whereas a lower percentage of these patients used EBMs to prevent CVD events. Strict use of EBMs, including beta-blockers, statins, and ACEIs or ARBs, can lead to more clinical benefits, even for patients with CAD and concomitant RI. Thus, treatment of this patient population with EBMs should be stressed. |
format | Online Article Text |
id | pubmed-4753913 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-47539132016-02-26 Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study Peng, Yong Xia, Tian-li Huang, Fang-yang Huang, Bao-tao Liu, Wei Chai, Hua Zhao, Zhen-gang Zhang, Chen Liao, Yan-biao Pu, Xiao-bo Chen, Shi-jian Li, Qiao Xu, Yuan-ning Luo, Yang Chen, Mao Huang, De-jia Medicine (Baltimore) 3400 The purpose of this study was to discuss the present situation of discharge medications in coronary artery disease (CAD) patients with different levels of renal function and assess the potential impact of these medications on the prognosis of this patient population. A retrospective cohort study was conducted. From July 2008 to Jan 2012, consecutive patients with CAD confirmed by coronary angiography of West China Hospital were enrolled and were grouped into 3 estimated glomerular filtration rate (eGFR) categories: ≥60, 30 to 60, and <30 mL/min/1.73 m(2). The endpoints were all-cause mortality and cardiac mortality. There are 3002 patients according to the inclusion criteria and follow-up requirement. The mean follow-up time was 29.1 ± 12.5 months. CAD patients with worse renal function included more cardiovascular risk factors (advanced age, history of hypertension or diabetes, and diagnosis of acute myocardial infarction). The cumulative survival curves of the patients according to renal function showed that the eGFR <30 mL/min and 30 mL/min ≤ eGFR <60 mL/min groups had a significantly higher risk of all-cause death and cardiovascular death than the group with an eGFR ≥60 mL/min. The prescription of evidence-based medicines (EBMs) at discharge (antiplatelet agents, beta-blockers, statins, and angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin-receptor blockers [ARBs]) was a factor in reducing the risk of all-cause death and cardiovascular death. However, EBMs prescribed at discharge revealed an obvious underuse in renal insufficiency (RI) patients. The results of Cox regression showed that irrespective of the eGFR level, greater use of EBMs resulted in a greater reduction in the risk of all-cause death and cardiovascular death. A higher percentage of patients with CAD and concomitant RI suffered from cardiovascular disease (CVD) risk factors, whereas a lower percentage of these patients used EBMs to prevent CVD events. Strict use of EBMs, including beta-blockers, statins, and ACEIs or ARBs, can lead to more clinical benefits, even for patients with CAD and concomitant RI. Thus, treatment of this patient population with EBMs should be stressed. Wolters Kluwer Health 2016-02-12 /pmc/articles/PMC4753913/ /pubmed/26871817 http://dx.doi.org/10.1097/MD.0000000000002740 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-sa/4.0 This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0 |
spellingShingle | 3400 Peng, Yong Xia, Tian-li Huang, Fang-yang Huang, Bao-tao Liu, Wei Chai, Hua Zhao, Zhen-gang Zhang, Chen Liao, Yan-biao Pu, Xiao-bo Chen, Shi-jian Li, Qiao Xu, Yuan-ning Luo, Yang Chen, Mao Huang, De-jia Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title | Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title_full | Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title_fullStr | Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title_full_unstemmed | Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title_short | Influence of Renal Insufficiency on the Prescription of Evidence-Based Medicines in Patients With Coronary Artery Disease and Its Prognostic Significance: A Retrospective Cohort Study |
title_sort | influence of renal insufficiency on the prescription of evidence-based medicines in patients with coronary artery disease and its prognostic significance: a retrospective cohort study |
topic | 3400 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753913/ https://www.ncbi.nlm.nih.gov/pubmed/26871817 http://dx.doi.org/10.1097/MD.0000000000002740 |
work_keys_str_mv | AT pengyong influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT xiatianli influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT huangfangyang influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT huangbaotao influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT liuwei influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT chaihua influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT zhaozhengang influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT zhangchen influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT liaoyanbiao influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT puxiaobo influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT chenshijian influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT liqiao influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT xuyuanning influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT luoyang influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT chenmao influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy AT huangdejia influenceofrenalinsufficiencyontheprescriptionofevidencebasedmedicinesinpatientswithcoronaryarterydiseaseanditsprognosticsignificancearetrospectivecohortstudy |