국내 3차병원에서 급성관상동맥 증후군 후에 퇴원처방약 패턴 및 관찰평가 분석

Abstract

Acute Coronary Syndrome (ACS) is one of cardiovascular diseases which are mainly caused by atherosclerotic plaque erosion and subsequent coronary thrombus formation. ACS is classified into three types: unstable angina (UA), non-ST elevated myocardial infarction (NSTEMI), and ST-elevated myocardial infarction (STEMI). According to 2014 AHA/ACC guideline, it is strongly recommended that aspirin ± clopidogrel, ACE-I/ARB, β-blocker, and statin should be prescribed to ACS patients discharged in order to prevent secondary ACS. The aims of this study were to analyze the prescription patterns of discharge medications after ACS and to perform follow-up evaluation. This study was retrospectively conducted through electronic medical record (EMR) which contained laboratory data and discharge medication lists for ACS patients in a tertiary hospital between September 2009 and August 2013. Out of 1,465 patients during the study period, 494 were selected based on inclusion and exclusion criteria of this study. At discharge, the patients who received the five recommended medications were 374 (75.71%), but the number of these patients remaining on this treatment 12 and 18 months after discharge were 169 (34.21%) and 105 (21.26%), respectively. Enoxaparin, an antithrombotic agent for the reduction of mortality and morbidity of ACS, was prescribed to 352 (71.40%) ACS patients right after admission. Of them, UA, NSTEMI, and STEMI patients were 173 (35.09%), 58 (11.76%), and 121 (24.54%), respectively. Troponin-T (TnT) is used as a biomarker for myocardial injury. hs-Troponin-T (hs-TnT) that is more sensitive than TnT has been measured for ACS patients in this hospital since November 2011. Further studies related to the association of the prevention for secondary ACS with using the strongly recommended discharge medications and follow-up clinical laboratory levels are needed to better optimize the treatment for ACS patients. In addition, the further follow-up evaluation studies regarding ACS medication patterns after 18 months should be conducted.