无锡地区急性心肌梗死治疗现状调查
무석지구급성심기경사치료현상조사
A multi-center survey on the therapeutic status of patients with acute myocardial infarction in Wuxi city of China
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2014年 4期 309-313 ,共5页

    郭素峡%羊镇宇%吴丁烨%杨承健%陶以嘉%陈风%苏伟%郑若龙%杨松

    곽소협%양진우%오정엽%양승건%도이가%진풍%소위%정약룡%양송

    心肌梗死%心肌再灌注%治疗结果%横断面研究 心肌梗死%心肌再灌註%治療結果%橫斷麵研究
    심기경사%심기재관주%치료결과%횡단면연구
    Myocardial infarction%Myocardial reperfusion%Treatment outcome%Cross-sectional studies
    目的 分析中国无锡地区急性心肌梗死(AMI)患者基线特征及治疗现状.方法 通过网络直报,2011年1月至2012年12月入选无锡9家医院1 714例AMI患者,其中非ST段抬高型心肌梗死(NSTEMI) 304例,ST段抬高型心肌梗死(STEMI)1 410例.男性1 334例,吸烟754例,高血压1 076例,高脂血症270例,糖尿病398例.分析AMI的药物使用、再灌注治疗、主要心血管事件(MACE)及住院期间全因病死率.结果 (1)药物治疗及再灌注治疗:服用抗血小板药物1 685例(98.3％),β受体阻滞剂1 013例(59.1％),血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)1 159例(67.6％),他汀类药物1 682例(98.1％),硝酸酯类1 218例(71.1％),行临时起搏132例(7.7％).1 410例STEMI患者再灌注治疗480例(34.0％),其中直接经皮冠状动脉介入治疗(PCI) 260例(18.4％),药物溶栓220例(15.6％).(2)诊治延迟时间:120急救车就诊361例,患者自行就诊1 318例,院内发生35例,3组发病至就诊中位数时间分别为178、368和9 min,发病至第1份心电图时间中位数分别为181、379和10 min,发病至接受专科治疗时间中位数分别为187、431和69 min,3组间差异均有统计学意义(P＜0.05).STEMI行再灌注治疗患者中,120急救车入院患者的发病至再灌注治疗时间明显短于自行入院者[溶栓组:224(171,514) min比378(158,785) min;PCI组:318(154,674)min比489(143,816)min,P均＜0.05].(3) MACE和院内全因死亡:1 714例AMI患者发生MACE 279例(16.3％),其中NSTEMI患者43例,STEMI患者236例;院内死亡224例(13.1％),其中NSTEMI患者28例,STEMI患者196例.按发病至就诊时间分为:＜3、3～6、6～12和12 h组,院内全因病死率分别为4.1％ (21/517)、10.4％ (47/451)、18.6％(75/404)和23.7％(81/342)(x2=84.36,P＜0.01),MACE发生率差异也有统计学意义(P＜0.01).急性STEMI患者分为直接PCI、溶栓和早期药物治疗组,其MACE[分别为5.8％ (15/260)、12.3％(27/220)和20.9％(194/930),x2=39.93,P＜0.01]及全因病死率[分别为1.5％(4/260)、10.0％(22/220)和18.2％(170/930),x2=50.90,P＜0.01]差异均有统计学意义.结论 无锡地区AMI患者药物治疗基本规范化,再灌注治疗占比偏低.院前延迟时间较多,而120急救车入院诊治延迟时间明显短于自行入院者.STEMI经直接PCI治疗患者的院内全因死亡和心血管事件发生率最低.
    목적 분석중국무석지구급성심기경사(AMI)환자기선특정급치료현상.방법 통과망락직보,2011년1월지2012년12월입선무석9가의원1 714례AMI환자,기중비ST단태고형심기경사(NSTEMI) 304례,ST단태고형심기경사(STEMI)1 410례.남성1 334례,흡연754례,고혈압1 076례,고지혈증270례,당뇨병398례.분석AMI적약물사용、재관주치료、주요심혈관사건(MACE)급주원기간전인병사솔.결과 (1)약물치료급재관주치료:복용항혈소판약물1 685례(98.3％),β수체조체제1 013례(59.1％),혈관긴장소전환매억제제(ACEI)혹혈관긴장소수체길항제(ARB)1 159례(67.6％),타정류약물1 682례(98.1％),초산지류1 218례(71.1％),행림시기박132례(7.7％).1 410례STEMI환자재관주치료480례(34.0％),기중직접경피관상동맥개입치료(PCI) 260례(18.4％),약물용전220례(15.6％).(2)진치연지시간:120급구차취진361례,환자자행취진1 318례,원내발생35례,3조발병지취진중위수시간분별위178、368화9 min,발병지제1빈심전도시간중위수분별위181、379화10 min,발병지접수전과치료시간중위수분별위187、431화69 min,3조간차이균유통계학의의(P＜0.05).STEMI행재관주치료환자중,120급구차입원환자적발병지재관주치료시간명현단우자행입원자[용전조:224(171,514) min비378(158,785) min;PCI조:318(154,674)min비489(143,816)min,P균＜0.05].(3) MACE화원내전인사망:1 714례AMI환자발생MACE 279례(16.3％),기중NSTEMI환자43례,STEMI환자236례;원내사망224례(13.1％),기중NSTEMI환자28례,STEMI환자196례.안발병지취진시간분위:＜3、3～6、6～12화12 h조,원내전인병사솔분별위4.1％ (21/517)、10.4％ (47/451)、18.6％(75/404)화23.7％(81/342)(x2=84.36,P＜0.01),MACE발생솔차이야유통계학의의(P＜0.01).급성STEMI환자분위직접PCI、용전화조기약물치료조,기MACE[분별위5.8％ (15/260)、12.3％(27/220)화20.9％(194/930),x2=39.93,P＜0.01]급전인병사솔[분별위1.5％(4/260)、10.0％(22/220)화18.2％(170/930),x2=50.90,P＜0.01]차이균유통계학의의.결론 무석지구AMI환자약물치료기본규범화,재관주치료점비편저.원전연지시간교다,이120급구차입원진치연지시간명현단우자행입원자.STEMI경직접PCI치료환자적원내전인사망화심혈관사건발생솔최저.
    Objective To explore the characteristics and therapies of patients with acute myocardial infarction (AMI) in Wuxi city,China.Methods A network was established to obtain information of patients with AMI who were admitted to 9 designated hospitals between 2011 and 2012.A total of 1 714 patients were enrolled (1 334 males,754 smokers,1 076 hypertension,270 hyperlipidemia and 398 diabetes) including 1 410 patients with acute ST-segment elevation myocardial infarction (STEMI) and 304 patients with acute non ST-segment elevation myocardial infarction (NSTEMI).Patients' characteristics,therapies,the incidence of major adverse cardiovascular events (MACEs) and all-cause mortality were analyzed.Results (1) Medication therapy was as follows:antiplatelet therapy 98.3％ (1 685 cases),beta-blockers 59.1％ (1 013 cases),ACEI or ARB 67.6％ (1 159 cases),statins 98.1％ (1 682 cases),and nitrates 71.1％ (1 218 cases).Of the patients,7.1％ (132 cases) received temporary pacemakers,34.0％ (480 cases) with acute STEMI underwent reperfusion [direct PCI 18.4％ (260 cases) and thrombolysis 15.6％ (220 cases)].(2) According to the hospital admission data,patients were divided into three groups:group A,transported to the hospital by ambulance (n =361) ; group B,transported to the hospital by private vehicles (n =1 318) ; and group C,AMI occurred in the hospital (n =35).The median time of AMI onset to physician contact of the 3 groups was 178 min,368 min,and 9 min,respectively.The median time from AMI onset to the first ECG was 181 min,379 min,and 10 min,respectively.The median time from AMI onset to cardiology specialist consultation was 187 min,431 min,and 69 min,respectively.AMI onset-to-physician contact,AMI onset-to-first ECG,and AMI onset-to-specialized treatment time was the shortest in group C,followed by group A and group B.For patients with STEMI underwent reperfusion therapy,the median AMI onset-to-reperfusion therapy time was significantly shorter in group A patients than group B patients [thrombolysis group:224(171,514) min vs.378 (158,785) min,PCI group:318(154,674)min vs.489(143,816) min,all P ＜0.05].(3) The total incidence of MACEs was 16.3％ (279/1 714),the all-cause in-hospital mortality rate was 13.1％ (224/1 714).According to the AMI onset-to-physician contact,patients were divided into 4 groups:＜ 3 h,3-6 h,6-12 h,and ＞ 12 h.The incidence of MACEs [4.4％ (23/517),13.3％ (60/451),19.1％ (77/404) and 34.8％ (119/342),x2=114.36,P ＜ 0.01] and all-cause in-hospital mortality rate [4.1％ (21/517),10.4％ (47/451),18.6％ (75/404),23.7％ (81/342),x2 =84.36,P ＜0.01] increased in proportion to the time of AMI onset-to-physician contact.Among STEMI patients,the incidence of MACEs [5.8％ (15/260),12.3％ (27/220),20.9％ (194/930),x2 =39.93,P ＜ 0.01] and all-cause in-hospital mortality [1.5％ (4/260),10.0％ (22/220),18.2％ (170/930),x2 =50.90,P ＜ 0.01] was the lowest in the primary PCI group,followed by thrombolysis group and was the highest in the early conservative treatment group.Conclusions Guideline is well followed in terms of drug treatments of AMI in this cohort,but only a small proportion of AMI patients in Wuxi received reperfusion therapy.There is a considerable out-of-hospital time delay for AMI patients in this cohort which is shorter in group A than in group B.All-cause in-hospital mortality and MACEs is the lowest in AMI patients underwent primary PCI.
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