Transcript Care For Your Heart Survey 2013

關心您的心
冠心病及其療法認知調查
SURVEY ON KNOWLEDGE OF
CORONARY HEART DISEASE AND TREATMENTS
傳媒發布會 Press Conference
19/11/2013
2
發布會內容
CONTENT
• 研究背景及目的
Research background & objectives
• 調查方法
Research methodology
• 調查結果及分析
Research findings & analysis
• 有關冠心病及其療法簡介
About Coronary Heart Disease & its treatment methods
• 個案分享及總結
Case Sharing & Conclusion
• 「關心您的心」近期活動
Care For Your Heart upcoming activities
研究背景及目的
RESEARCH BACKGROUND & OBJECTIVES
4
「關心您的心」介紹
About CARE FOR YOUR HEART
•
成立於一九九五年十一月，是首個由患有各類心臟病患者及家屬組成的社區互助組織
Founded in 1995, Care For Your Heart is the first community-based cardiac patients
self-help association
•
得到榮譽贊助人梁唐青儀女士的鼎力支持並由各界專業人士，包括心臟專科醫生、營養師、
物理治療師、社會工作者、護士及職業治療師等擔任名譽顧問
The association has been supported by Mrs. Regina Leung as Patron of the
association and a board of Honorary Advisers from various specialties, including
cardiologists, dietitians, pharmacists, social workers, nurses, therapists and other
professionals
•
本會致力為病友及市民大眾提供全面心臟健康及復康服務
The association is committed to provide comprehensive heart health and
rehabilitation service to patients and public
•
服務宗旨為發揮會友及家屬互助互勉精神，解開因病帶來的困惑和恐懼。攜手共進復康之
路，邁向豐盛人生。
To promote mutual support and self-help among cardiac patients and family
members for betterment in heart health and well being of life
•
本會的服務範圍包括舉辦心臟復康活動、病友互助小組及分享聚會、病友關懷服務、心臟
健康推廣活動、心臟資料製作及權益爭取及倡導。
Our services include cardiac rehabilitation service, patients mutual support groups
and caring service, telephone counseling, public heart health promotion, production
of education materials and advocacy
5
研究背景及目的
Research Background & Objectives
• 心臟病是香港第三號殺手。在各種心臟病當中，冠心病是引致心臟病死亡的主因，佔
68.9%*
Heart disease is the 3rd highest cause of death in Hong Kong and Coronary
Heart Disease (CHD) makes up 68.9%* of heart diseases deaths
• 現時冠心病療法當中，進行「通波仔」植入心臟支架為香港最常見的療法
PCI stenting is a common treatment for CHD
• 而在「通波仔」支架選擇上，亦該因應病人不同的身體情況而作出不同的選擇
Patients should talk with their doctors to choose the most suitable stents
according to the different patient conditions
• 有見及此， 心臟病人互助組織「關心您的心」進行香港冠心病患者對「通波仔」療法的
認知調查，旨在了解本港冠心病患者對「通波仔」療法選擇及其服藥療程的認知，亦藉
此增進市民對療法選擇的了解
Care For Your Heart, the cardiac patients mutual support association, conducted a
knowledge survey of PCI treatment options and associated medication among
CHD patients in Hong Kong, with the objective of enhancing understanding of the
treatment among the community and the general public
* 香港衛生署 2011年統計數據（2011 Data, Department of Health）
調查方法
RESEARCH METHODOLOGY
7
調查方法
Research Methodology
• 調查日期 (Interview period)：
2013年7月15日 – 2013年8月2日
July 15 – Aug 2, 2013
• 訪問對象 (Target sample)：
「關心您的心」病友 （曾進行通波仔手術的冠心病病人）
Members of Care For Your Heart (Patients who had undertaken PCI)
• 調查方法 (Methodology) :
由「關心您的心」訪問員對該病友組織的患者進行電話訪問
Interviewers of Care For Your Heart to conduct telephone interview with the members
of the association
8
調查方法
Research Methodology
• 問卷主要研究以下部份
(The questionnaire mainly looks into the following parts)：
▫ 對「通波仔」療法植入支架種類的認知
The knowledge about different types of stents
▫ 對進行「通波仔」後服藥療程的認知
The knowledge about medication after PCI
▫ 對常規心臟健康檢查重視程度
The awareness of the importance of regular heart health test
▫ 冠心病患者獲取療法資訊的途徑
The information channels of CHD for patients
• 樣本數目(Sample size)：215個成功個案 (215 successful cases)
• 有效回應比率(Respond rate): 87.8%
9
樣本年齡及性別分布
Distribution of Sample by Age Group
and Gender
• 受訪者年齡介乎36歲至89歲之間，大多數（67.4%）受訪者介乎61歲至
80歲；樣本中男性佔七成五
The sample population was aged between 34-89 and the majority (67.7%) aged between
61-80. About 75% of respondents were male
81歲或以上
50歲或以下
年齡分布
12.6%
6.0%
性別分布
51至60歲
14.0%
女性
25.6%
71至80歲
61至70歲
38.1%
29.3%
男性
74.4%
研究結果及分析
RESEARCH FINDINGS & ANALYSIS
11
對心臟健康的注意程度
Awareness of Heart Health
過去一個月你曾否接觸過有關心臟病的資訊？
Have you ever come into contact with information about heart disease
over the past month?
沒有
35.3%
有
64.7%
 逾三成半受訪者在過去一個月沒有接觸有關心臟病的資訊
Over 35% of respondents had not came into contact with information about
heart disease over the past month
12
對心臟健康的注意程度
Awareness of Heart Health
你是否有興趣閱讀有關「通波仔」手術的資料？
Are you interested in reading information related to PCI?
沒有
40.9%
有
59.1%
 過半數受訪者十分樂意了解更多關於冠心病資訊
Over 50% of respondents are interested in reading information related to PCI
13
心臟病療法及護理資訊來源
Source of Getting Treatments Information
你是透過什麼渠道瞭解心臟病療法及護理資訊？
你覺得資訊是否足夠?
Where did you get information about treatments of
Do you think there is enough information?
heart disease?
其他
否
0.6%
16.3%
大眾媒體（報章、雜誌、電視、電台、網…
11.3%
健康講座
醫院壁布板
29.1%
4.9%
醫療機構、病人組織出版物 （書刊、小冊…
33.3%
心臟科醫生
0.0%
83.7%
20.7%
10.0%
20.0%
是
30.0%
 超過六成受訪者表示通過健康講座或小冊子瞭解心臟病療法
Over 60% of respondents indicated that health talks, leaflets and booklets were the main source
of getting information about treatments of heart disease
 仍有超過一成六受訪者認為坊間有關心臟病療法的資料不足夠
There is still 16% of respondents expressed that there is not enough information about heart
disease treatments out there
14
對支架的認識
Knowledge on Stent Options
你能否講出「通波仔」所用的心臟支架有
那些類型?
Can you name the stent types that is
available for PCI?
沒有答中任
答中其中一
何一種支架
種支架
29.3%
27.9%
答中三種支
架或以上
17.7%
答中其中兩
種支架
25.1%
 接近三成受訪者未能講出任何一種支架類型
Almost 30% of respondents could not
name any one type of stent
 僅一成七受訪者能答中三種以上支架
Only 17.7% of respondents were able to
name 3 or more types of stent
 現時香港共有五種支架可供選擇 - 裸金屬支
架、藥物塗層支架、生物工程支架、全吸收式
生物血管模架及最新推出的雙療法支架
There are 5 types of stent available for PCI
in Hong Kong – Bare Metal Stent, Drug
Eluting Stent, Bio-engineered Stent,
Bioresorbable Vascular Scaffold and the
latest Dual Therapy Stent
15
植入支架類型
Stent Implanted
你植入了什麼類型的支架？
What type of stent did you implant?
其他
2.3%
雙療法支架
0.5%
全吸收式生物血管模架/可溶解支架
0.9%
生物工程抗體支架/ 抗體塗層支架
0.9%
藥物塗層支架/ 塗藥支架
52.1%
裸金屬支架
不清楚
0.0%
32.6%
18.1%
20.0%
40.0%
60.0%
 接近兩成受訪者不清楚自己血管內所植入的支架類型
18% of respondents did not know the type of stents that has been implanted in
their vessels
 超過一半受訪者植入了藥物塗層支架
More than half of the respondents were implanted with Drug Eluting Stent
16
選擇支架準則
Criteria when Selecting Stent
你當時以什麼準則選擇支架？
How did you select the type stent for PCI?
其它
0.8%
術後藥物療程長短
0.0%
其它人建議
0.0%
醫生建議
價錢
安全性
療效
0.0%
78.6%
7.1%
4.2%
9.2%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
 接近八成受訪者聽從醫生建議選擇支架類型
78% of respondents followed doctor’s recommendations when selecting stents
 僅約一成受訪者以支架療效作為選擇準則
Only 10% of the respondents chose the stent because of its efficacy
17
了解心臟支架種類的主動性
Intention to Know More about Stents
你曾否主動向醫生了解「通波仔」所用心臟支架
的種類?
Had you proactively looked for, or tried to understand
more information about coronary stents from your
doctor?
100
50
38.1%
53.0%
有
沒有
8.8%
0
不記得
你認為手術前醫生在解釋各種支架的分別時是否
足夠？
Do you think that your doctors have explained enough
150
about stent choice before the surgery?
100
50
61.4%
38.6%
是
否
0
 即使接近八成受訪者聽從醫生建議選擇支
架，仍有約四成認為在術前沒有得到足夠
有關支架的資訊，但同時超過一半受訪者
表示從未向醫生主動了解
Although almost 80% of respondents
depended on doctors when choosing
stent, still about 40% believed that they
did not receive enough information
from their doctors; however, over 50%
did not actively seek for stent
information from their doctors
 若對支架選擇存有疑問或認知不足，我們
鼓勵病人應多發問，及主動向醫生了解
Patients are encouraged to asked more
if they do not understand about the
stent options
18
支架及所配合藥物療程的認知
Knowledge of Stents and Its Medical Treatment
請問你是否知道植入不同類型心臟支架後  逾半受訪者知道植入不同類型支架，醫生所建
議的服藥時期會有所不同。 但仍有四成七受訪
者表示不知道
所需的服藥時間有所不同？
More than half of the respondents realized
Do you know that the period of medication
that the medication treatment period varies
varies among patients implanted with
between stents, but still there is 47% of
them did not know about this
different type of stents?
不知道
47.4%
知道
52.6%
 一般來說， 不帶藥及有抗體塗層的支架服藥期
較短， 植入藥物塗層支架則需長期 (不少於12
個月) 服用雙重抗血小板藥物。而植入雙療法
支架，根據研究指引需服藥6個月
In general, medication treatment after
implanting stents without drug or with
antibody-coating would be shorter. With
Drug Eluting Stents, patients would be
required to take longer period (not less
than 12 months) of dual antiplatelet
therapy. And for Dual Therapy Stent,
according to study’s protocol, 6 months
medication is recommended
19
服藥時間
Period of Medication
 超過九成受訪者於術後需服用雙重抗血小板
藥物12個月或以上，逾半更需要永久服用
Over 90% of respondents has been
instructed to take DAPT for 12 months or
more, more than 50% need to take DAPT
for life
你在進行「通波仔」手術後，醫生指示你
該服用雙重抗血小板藥物多少時間？
How long did your doctors instructed you
to take the DAPT after the surgery?
需永久服用
51.6%
多於12個月
19.1%
12個月
20.5%
6個月
4.2%
3個月
3.7%
1個月
4.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
 雙重抗血小板藥物的作用為減低血塊形成的
機會，降低血管栓塞的風險
The use of DAPT is for preventing the
formation of blood clots in order to
reduce the risk of thrombosis
 長期服用雙重抗血小板藥物有機會增加出血
風險， 服藥期間要動其它手術而需要停藥的
病人，血管栓塞的風險亦會增加
Long-term DAPT might increase the risk
of bleeding. For patients who need to
stop the medication due to near-term
surgery, risk of thrombosis will also
increase
60.0%
20
服藥依從性
Medication Compliance
你在進行「通波仔」手術後是否曾經忘記或停
止服用雙重抗血小板藥?
Have you ever forgotten or stop taking DAPT
after implantation of stent?
少於1星期1次
多於1個月1次
0.0%
多於1星期1次
0.5%
1.9%
少於1個月1次
26.5%
從不
71.2%
 有近三成受訪者表示曾經忘記服用雙重抗血
小板藥物
29% of respondents have experienced
forgetting to take prescribed medicine
DAPT on time after undergoing PCI
21
需要停藥的情況
Termination of Medication
如你曾經停止服用雙重抗血小板藥，是
因為什麼原因？
If you have ever stopped taking DAPT,
what was the reason?
要進行手術
5.1%
 約半成受訪者表示曾經因要進行手術以停藥，
兩成三則根據醫生指示暫停或停止服用
About 5% of the respondents indicated
that they had to terminate the medication
due to surgery. 23% was instructed to
suspend or terminate the medication by
their doctors
 而逾七成半受訪者於未有醫生指示下自行停
藥，當中原因以忘記服用為最多 (66%)，亦有
人表示因不知道是否需要，或認為不需要而決
不知道是否需要
2.3%
定暫停或停止服用雙重抗血小板藥物
價錢
0.9%
More than 75% of the respondents had
stopped taking DAPT without doctor’s
認為不需要
1.4%
instruction, most of them (66%) said they
有出血情況
3.7%
have forgotten to. Some of them
expressed that they suspended or
副作用
0.9%
terminated due to the uncertainty of the
忘記
66.0%
need for the medication or felt that there
was no need to take the medication
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
醫生指示
23.3%
22
醫生所提供有關藥物的資訊
DAPT Information from Doctors
於手術後，醫生有否告訴你於服藥期間如需  超過六成受訪者表示醫生於手術後有告訴他
們於服藥期間如需進行其它手術或有出血情
進行其它手術或有出血情況出現你應該怎麼
況出現應該怎麼做
More than 60% of respondents said that
做？
doctors had told them what they should
Did your doctor tell you what you should do if
do if they need to undertake other
you need to undertake other surgery or
surgery or bleeding occurred during the
medication period
bleeding occurred during your medication
period?
不記得
9%
沒有
29%
有
62%
 建議市民如有需要進行「通波仔」，應主動
瞭解多一點有關服藥的資訊， 以及自己的身
體狀況是否適合長期服用抗血小板藥物。
It is suggested that patients should take
the initiative to acquire more information
about the medication, and to learn if their
own condition is suitable for long-term
DAPT
23
服藥依從性
Medication Compliance
當你覺得身體狀況好轉，會否停止服用雙重抗血
如你服用雙重抗血小板藥後感到不適，會否停止
小板藥?
服用雙重抗血小板藥?
Would you stop taking DAPT if you feel
Would you stop taking DAPT if there were
better?
side effect symptoms?
會
會
13.5%
17.2%
不會
不會
86.5%
82.8%
 大部份受訪者均表示即示身體狀況好轉(87%)或感到不適(83%)亦不會自行停藥
Most of the respondents indicated that they would not stop taking DAPT even if they
feel better (87%) or experience side effect symptoms (83%)
 但仍有逾一成表示即使醫生沒有許可， 仍會自行停藥
However, there was still more than 10% of the respondents expressed that they would
stop taking DAPT without doctor’s permission
24
不依時服藥風險的認知
Knowledge of Associated Risks of
Medication Non-compliance
你是否知道進行「通波仔」手術植入心
臟支架後沒有按時服藥的風險?
What are the risks of not taking dual
anti-platelet drugs (DAPT) on time?
其他
沒有風險
 僅4 人 (1.9%) 意識到擅自停藥或會導致死亡
Only 4 respondents (1.9%) mentioned
that it may lead to death
1.9%
3.7%
血塊形成/血栓
54.0%
血管再狹窄
心絞痛
不清楚
 逾半數受訪者均能講出植入心臟支架後沒有
按時服藥的最大風險 - 血塊形成及血栓
More than half of the respondents were
able to identify the largest risk of not
taking DAPT on time - Blood Clot
Formation and Thrombosis
35.8%
17.2%
36.7%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
 仍有逾三成半受訪者未能講出任何有可能出
現的風險
There were still 37% could not identify any
one of the possible risks
有關冠心病及其療法簡介
ABOUT CORONARY HEART DISEASE &
ITS TREATMENT METHODS
26
冠心病簡介
About Coronary Heart Disease
冠狀動脈心臟病」簡稱冠心病，是指環繞心臟
的冠狀動脈因脂肪及膽固醇積聚而變得狹窄或
閉塞。病人會因此血液流動不良，導致心肌缺
氧，嚴重的甚至會引致心肌壞死，令患者心跳
停頓而突然猝死
Coronary Heart Disease (CHD) refers to
the narrowing and obstruction of arteries
supplying blood to the heart through
progressive accumulation of fat and
cholesterol which leads to poor blood
circulation, myocardial anoxia and even
causes myocardial necrosis. In the worst
case scenario, patients may die due to
sudden cardiac arrest, or more commonly
known as heart attack
27
冠心病簡介
About Coronary Heart Disease
冠心病主要成因
The causes of CHD include
•
•
•
•
•
•
•
•
膽固醇過高 (Excess cholesterol level)
吸煙 (Smoking)
過胖 (Excess fat)
糖尿病 (Diabetes)
高血壓 (Hypertension)
生活緊張，壓力過大 (Stressful lifestyle under high pressure)
缺乏運動 (Lack of exercise)
家族遺傳 (Family history)
28
冠心病簡介
About Coronary Heart Disease
冠心病目前的治療方法
Current treatments for CHD include
• 藥物治療
Drug Treatment
• 冠狀動脈介入手術, 俗稱「通波仔」
Percutaneous Coronary Intervention (PCI)
• 冠狀動脈搭橋手術
Coronary Artery Bypass Graft Surgery
29
有關冠心病及其療法簡介
About Coronary Heart Disease &
Its Treatment Methods
冠狀動脈介入手術, 俗稱「通波仔」過程 簡介
The simple steps of PCI stenting
1. 一個帶球囊的導管穿
過血管狹窄處
Balloon catheter is
advanced through the
site of arterial stenosis
2. 導管前端的球囊擴
張，擴開血管狹窄處
Balloon catheter is
dilated at lesion site to
open up channel for
blood circulation
3. 球囊回縮變小並撤出
The balloon catheter is
deflated and
withdrawn
4. 帶有支架的導管再次進入狹
窄處，球囊導管擴張，支架同
時被撐開釋放
Stent pre-mounted on balloon
catheter is then delivered to
lesion site and deployed
5. 球囊回縮變小撤出，支架將
永久置入血管內
Balloon catheter is withdrawn
and the stent remains in the
artery permanently
30
31
認識冠狀動脈支架
Coronary Stents

一般情況下， 如冠狀動脈狹窄的情況不太嚴重，可以使用藥物控制病情。不
過， 當血管收窄60%-70%以上， 便要考慮進行冠狀動脈介入治療術， 將冠
狀動脈支架植入， 支撐著血管。同一樣的支架並非完全適用於每位病人，醫
生需視乎病人的情況而選擇使用哪一類型支架。如血管病變程度、禁忌症和經
濟狀況等
In general, if coronary stenosis is not severe (<50%), medication treatment
might be advised to control the disease. However, with arterial blockage in
excess of 60% to 70%, Percutaneous Coronary Intervention (PCI) would
probably be recommended and the procedure often involves the implantation
of coronary stent(s) to provide scaffolding to keep the coronary artery open
permanently.
In general, stent selection depends primarily on patients’ baseline
characteristics; lesion type, contra-indications and patients’ financial situation
may also be factors for consideration
32
認識冠狀動脈支架
Coronary Stents


金屬網格管狀支架用於通波仔手術後 現時支架大致可分五類：
用以永久支撐血管
There are currently 5 types of stents
A metal mesh tube used to provide
available in the market:
permanent scaffolding to keep
 裸金屬支架 (Bare Metal Stent)
coronary arteries open, usually
 單療法支架 (Mono-therapy Stent)
following a balloon angioplasty
 藥物塗層支架
(Drug Eluting Stent)
 生物工程支架
不同類型支架都具有其獨特的屬性、
(Bio-engineered Stent)
優點和缺點
Various stent types with each
 全吸收式生物血管模架
having its distinctive properties as
(Bioresorbable Vascular Scaffold)
well as advantages and
 雙療法支架 (Dual Therapy Stent)
disadvantages
33
裸金屬支架
Bare Metal Stent
34
裸金屬支架 (BMS)
性質 Properties
• 純金屬支架，植入心血管後能將血管阻塞的地方張開，令血液能再次暢通運行
A plain metallic scaffolding without any coating that can immediately widen the
blockage area (lesion) within the blood vessel after implantation to facilitate
regular blood flow
強項 Advantages
• 費用較其他種類的支架便宜；而手術後一般只需服用一個月雙重抗血小板藥物（如: 柏域
斯及阿士匹靈）
Costs are relatively cheap. After implantation, patient will need to take one to
twelve months dual anti-platelet therapy (i.e. Plavix and aspirin)
弱項 Disadvantages
• 因血管內壁的細胞過度增生而導致心血管再次收窄的機率相對較高
A relatively higher chance of vessel re-narrowing or restenosis as a result of
hyperplasia caused by vessel trauma during stent implantation
35
單療法支架
Mono-therapy Stent
36
藥物塗層支架 (DES)
性質 Properties
• 備有藥物塗層的金屬支架，藥物會慢慢滲透入血管壁，減少細胞增生，防止血管再度收窄
An anti-proliferative drug is embedded in a polymer coated on the stent’s surface
and is gradually released and absorbed through the vessel, reducing cell
proliferation or hyperplasia, preventing re- narrowing of the vessel
強項 Advantages
• 減低心血管再次收窄機會
Effectively reduce the chances of In- Stent Restenosis (Re- narrowing)
弱項 Disadvantages
• 手術後因抑制了內皮祖細胞的增長，有礙血管癒合，增加支架位置形成血栓的機會，故需
長期（不少於12個月）服用雙重抗血小板藥物
Anti-proliferative drug inhibits the growth of endothelial progenitor cells, delaying
the natural healing process and increasing the chance of stent thrombosis.
Recommended dual anti-platelet therapy (DAPT) is a minimum of 12 months
37
全吸收式生物血管模架 (BVS)
性質 Properties
• 塗有藥物的可溶性模架會隨著時間分解然後被人體自然吸收
A new type of drug coated stent platform which could naturally be absorbed and
metabolized by the body in time, leaving no permanent implant in blood vessels
強項 Advantages
• 能抑制血管壁細胞增生的藥物塗在可分解性塑膠物料而製的模架上，減低血管再次收窄機
會，而模架則在植入血管兩年後消失
Coated with an anti-proliferative drug to minimize re-narrowing and the
biodegradable scaffold will be dissolved after two years
弱項 Disadvantages
• 由於這種模架的獨特物料結構的關係，如患有血管嚴重鈣化，迂曲或分叉病變等之病人可
能不適用
Due to scaffold material, may not be suitable in patients with calcified, tortuous and
bifurcation lesions
38
據歐洲心臟病醫學會/歐洲心胸外科學會指引
不適宜使用藥物塗層支架的病人
ESC/EACTS Guidelines on Contraindications to DES
39
生物工程支架
性質 Properties
• 支架內壁塗有抗體，吸附血液中的內皮祖細胞成為內皮層覆蓋支架表面，加快血管自然修
復過程，降低血栓及血管再收窄的機會
Stent is coated with antibodies that rapidly capture circulating endothelial
progenitor cells in the blood stream, accelerating the natural healing process
(endothelization) and reducing the chance of stent thrombosis and vessel renarrowing
強項 Advantages
• 加快血管壁自然修復過程，因此能減低晚期血栓及心血管再收窄的機率。醫生一般建議手
術後只需服用雙重抗血小板藥物一個月
Accelerated natural healing process reduces chance of late stent thrombosis and
vessel re-narrowing. Recommend DAPT of one month after stent implantation
弱項 Disadvantages
• 生物工程支架是一個自然癒合過程，它沒有殺死細胞的藥物塗層，
因此第一年再收窄的機會略高於藥物塗層支架
Absence of an anti-proliferative drug to suppress cell
proliferation, resulting in a higher chance of vessel renarrowing within the first year
40
再狹窄 v.s. 血栓 Restenosis vs.Thrombosis
（有效性 與 安全性）(Efficacy vs. Safety)
再狹窄Restenosis
先前經通波仔治療過的血管
再狹窄或再出現阻塞
Re-narrowing or blockage of
a previously-treated artery
by coronary angioplasty
血栓Thrombosis
在血管成植入支架範圍出現
或形成血塊
Presence or formation of
blood clots in a vessel or on
stented area
一般血栓形成導致的死亡機率比再狹窄相對較高的（45％）， 患者通常需要
再接受治療
Thrombosis in general leads to a relatively higher chance of death (45%)
compared with restenosis which usually results in need of re-treatment
* Iakovou, I. et al. JAMA 2005;293:2126-2130
41
支架血栓的死亡率
Death Following ST
隨訪期間（％） 植入支架後內血栓形成的死亡率
Mortality During Follow up (%) Post-Stent Thrombosis
患
者
%
HR 13.1 (9.8–17.5)
P<0.0001
N=210
N=12634
Wiviott SD, et al. Lancet. 2008.
42
最新型支架
Latest Stent
Available
43
雙療法支架
Dual Therapy Stent
44
雙療法支架 (DTS)
性質 Properties
• 全球第一隻擁有雙重療效的支架。結合了生物工程支架和藥物塗層支架的特性和優點，
能同時修復血管内皮層並控制血管壁內膜增生
A first-of-its-kind stent combining an anti-proliferative drug (on the abluminal
surface) to control neointimal proliferation and an antibody (on the luminal
surface) to accelerate endothelial coverage
強項 Advantages
• 支架外壁上塗有藥物，能抑制血管壁細胞增生而降低再狹窄的機會。支架内壁則附有抗
體，加快血管內皮層自然修復，從減低早期及晚期血栓之形成
Anti-proliferative drug reduces vessel re-narrowing whist antibody promotes
endothelialization or stent coverage, reducing the risk of stent thrombosis.
弱項 Disadvantages
• 術後服用雙重抗血小板藥物的時間較裸支架及生物工程支架為長
DAPT duration is longer than the period of Bare Metal Stent and Bio-engineered
Stent
45
雙療法支架 (DTS)
47
雙療法支架 (DTS)
光學相干斷層掃描(OCT)影像顯示植入
單療法藥物塗層支架9個月後的支架
內膜覆蓋情況
OCT images of a monotherapy DES at
9 months with heterogeneous
coverage
光學相干斷層掃描(OCT)影像顯示植入
雙療法支架9個月後的支架
內膜覆蓋情況
OCT images of Dual Therapy Stent at
9 months showing homogeneous
coverage
48
支架列表 Stent Choices
祼金屬支架
(Bare Metal Stent)
藥物塗層支架
(Drug-Eluting
Stent)
生物工程支架
(Bio-engineered
Stent)
全吸收式生物血管模架
(Bioresorbable
Vascular Scaffold)
雙療法支架
(Dual Therapy
Stent)
性質
純金屬支架，植入血管
後能令阻塞的血管張開
表面塗有藥物的金屬支
架；藥物會抑制
血管內膜增生，防止血
管再度收窄
支架表面塗有抗體，
抗體會吸附血管中的
内皮祖細胞，加快支
架表面自然修復過程
塗有藥物的可溶性模架會
隨著時間分解然後被人體
自然吸收
全球第一隻雙療法支
架。結合了生物工程
支架和藥物塗層支架
的特性。支架內壁附
有抗體，吸引血液中
的內皮組細胞，加快
血管自然修復過程；
而支架外壁塗有藥物，
抑制平滑肌細胞及血
管內膜增生
強項
1. 第一代傳統裸金屬支 1. 有效減低心血管再次
收窄機率
架
2. 費用相對便宜
3. 手術後只需服用一個
月雙重抗血小板藥 (如：
柏域斯及阿士匹靈)
1. 加速血管自然修復
2. 減低晚期血栓及血
管再收窄的機率
3. 毋須長期服用雙重
抗血小板藥物，但醫
生一般建議手術後服
用此藥物一個月
1. 藥物能抑制血管內膜增
生，減低血管再次收窄機
會
2. 模架在植入血管兩年後
消失
1. 能同時減低心血管
再次收窄率，並加快
支架表面修復從而減
低血栓發生率
弱項
因放入支架後會引致血
管受損，令血管內壁的
細胞會過度增生，導致
血管再次收窄的機會相
對較高
手術後因抑制了血管內
膜的增長，有礙血管癒
合，增加支架內形成血
栓的機會，故需要長期(
不少於12個月)服用雙重
抗血小板藥物
生物工程支架加快血
管自然癒合過程，它
沒有抑制細胞生長的
藥物塗層，因此第一
年再收窄的機會略高
於藥物塗層支架
由於這種模架的獨特物料
結構的關係，患有血管嚴
重鈣化，迂曲或分叉病變
等之病人可能不適用
服用雙重抗血小板藥
物時間比裸金屬支架
較長
手術後服藥
時間
1個月
12個月
1個月
12個月
6個月
(根據REMEDEE臨床
研究指引)
49
手術後的藥物治療
Post Surgery Medication Treatment
• 雙重抗血小板藥物是指阿士匹靈及氯格雷兩種抗血小板藥物，作用是減低裝有支
架的血管部位血塊形成的機會，從而減低血栓的風險
Dual-antiplatelet therapy (DAPT) with aspirin and a thienopyridine
( clopidogrel or ticlopidine) reduces blog clotting/ thrombotic events
• 五種支架由於其原理不同，所需服食雙重抗血小板藥物的時間長度亦不同
The period of DAPT varies among patients implanted with the five different
type of stents
• 醫生一般建議植入裸金屬支架及生物工程抗體支架的病人服藥1個月，而植入藥
物塗層支架及全吸收式生物血管模架的病人則須服用12個月或以上 。植入雙療法
支架的病人，根據研究指引，建議服藥6個月
Normally doctor would recommend patients who implanted BMS or Bioengineered Stents to undergo 1-month DAPT, while patients who implanted
DES or BVS need to undergo more than 12 months or above DAPT. For
those with DTS, according to study’s protocol, 6 months is recommended
50
調查總結
CONCLUSION
對支架選擇認知不足
Low Awareness about Stent Selection
•現時香港共有五種支架可供選擇 - 裸金屬支架、藥物塗層支架、生物工程支架、全吸收式生物血管模
架及最新推出的雙療法支架。接近三成受訪者未能講出市面任何一種的名稱，僅一成七認識三種或以
上支架
There are 5 types of stent available for PCI – Bare Metal Stent, Drug Eluting Stent, Bioengineered Stent, Bioresorbable Vascular Scaffold and the latest Dual Therapy Stent. About
30% of respondents could not name any types of stent available in the market; Less than 18%
of the respondents were able to give the name of 3 or more types of stent in the market
•接近兩成受訪者不清楚自己血管內所植入的支架類型
18% of respondents did not know the type of stents that has been implanted in their vessels
51
調查總結
CONCLUSION
對支架選擇認知不足
Low Awareness about Stent Selection
•逾半受訪者並沒有主動了解不同心臟支架種類的資訊，表明患者了解支架的種類風險、成效的主動性
不高
More than half of the respondents did not proactively look for or try to understand more
information about coronary stents . It shows that patients’ intention to know more about the
treatment methods is low
•接近一半 (47%) 的受訪者表示並不清楚不同的心臟支架，醫生所建議的服藥時期有所不同；一般來
說， 不帶藥及有抗體塗層的支架服藥期較短， 而藥物塗層支架則需長期 (不少於12 個月) 服用雙重抗
血小板藥物
47% of the respondents did not know that the medication period varies according to stent. In
general, medication treatment after implanting stents without drug or with antibody-coating
would be shorter. With Drug Eluting Stents, patients would be required to take longer period
(not less than 12 months) of dual antiplatelet therapy
•建議病人在進行「通波仔」之前應主動瞭解清楚各種支架選擇的特質，和醫生商量最為適合自己身體
狀況的支架
It is recommended that patients should proactively talk to their doctor to learn more about
different types of stent, so as to select the most suitable one for themselves
52
調查總結
CONCLUSION
對植入支架後服用藥物認知不足
Low Awareness about Medication after Stenting
•
雙重抗血小板藥物的作用為減低血塊形成的機會，降低血管栓塞的風險。超過九成受訪者於術後
需服用雙重抗血小板藥物12個月或以上，逾半更需要永久服用。 不過，仍有逾七成半受訪者曾經
於沒有醫生指示下自行停藥，當中原因以忘記服用為最多 (66%) ，亦有人表示因不知道是否需要
或認為不需要而決定暫停或停止服用雙重抗血小板藥物
The use of DAPT is for preventing the formation of blood clots in order to reduce the risk of
thrombosis. Over 90% of respondents have been instructed to take DAPT for 12 months or
more, more than 50% need to take DAPT for life. However, more than 70% of the
respondents had stopped taking DAPT without doctor’s instruction, most of them (66%)
said they have forgotten to. Some of them expressed that they suspended or terminated
due to uncertainty of the need of the medication or felt that there was no need to take the
medication
•
逾一成受訪者表示即使沒有醫生沒有許可， 服藥後身體狀況好轉或感到不適會自行停藥， 低估自
行停藥的風險
There were still more than 10% of the respondents expressed that they would stop taking
DAPT without doctor’s permission if they feel better or experience side effect symptoms
after taking the medication. The figures show that the risk of stopping taking DAPT has
been underestimated
53
調查總結
CONCLUSION
對植入支架後服用藥物認知不足
Low Awareness about Medication after Stenting
•
僅4 人 (1.9%) 意識到擅自停藥或會導致死亡，嚴重低估服用雙重抗血小板藥物的重要性
Only 4 respondents (1.9%) mentioned that it may lead to death, the importance of taking
DAPT has not been taken seriously
•
建議冠心病患者應清楚理解支架所需服食藥物的功用及擅自停藥所引發的血栓風險，並在手術後
按照醫生的囑咐按時服藥
It is recommended that patients should understand clearly the risk associated with DAPT
termination and follow doctor’s instruction to take drugs on time
54
調查總結
CONCLUSION
提高市民對冠心病的警覺性
To Enhance Public Awareness about Coronary Heart Disease
•
即使已接受過「通波仔」手術，仍然有超過四成受訪者對閱讀有關「通波仔」手術的資料不感興
趣， 顯示市民對冠心病的警覺性不足
Although all the participants have undertaken PCI, still over 40% of respondents were not
interested in reading information related to PCI. This figure shows that public awareness on
coronary heart disease is low
•
超過八成受訪者表示通過健康講座或小冊子瞭解心臟病療法，表明除醫生外， 患者能於多個途徑
接觸到心臟病資訊。建議關心您的心及業界應加強在這方面的推廣， 進一步提高大眾對冠心病的
警覺性
Over 80% of respondents indicated that health talks, leaflets and booklets were the main
source of getting information about treatments of heart disease other than from their
doctors. This figure shows that patients are able to reach heart disease information from
multiple channels. It is suggested that Care For Your Heart and the industry should
enhance the promotion of patient education, to further raise the public awareness of
coronary disease
55
「關心您的心」近期活動
Upcoming Activities
08/12/2013 星期日
同行萬步護心路 2013
Walk For Your Heart
9.30am ~ 1.00pm
*特設心臟病知識展覽
供公眾人士觀閱*
謝謝！
THANK YOU!