Gottlieb S, Boyko V, Harpaz D, Hod H, Cohen M, Mandelzweig L, Khoury Z, Stern S, Behar S
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
J Am Coll Cardiol. 1999 Jul;34(1):70-82. doi: 10.1016/s0735-1097(99)00152-7.
This survey sought to assess the frequency of the use of thrombolytic therapy, invasive coronary procedures (ICP) (angiography, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting [CABG]), variables associated with their use, and their impact on early (30-day) and long-term (3-year) mortality after acute myocardial infarction (AMI).
Few data are available regarding the implementation in daily practice of the results of clinical trials of treatments for AMI and their impact on early and long-term prognosis in unselected patients after AMI.
A prospective community-based national survey was conducted during January-February 1994 in all 25 coronary care units operating in Israel.
Among 999 consecutive patients with an AMI (72% men; mean age 63+/-12 years) acute reperfusion therapy (ART) was used in 455 patients (46%; thrombolysis in 435 patients [44%] and primary angioplasty in 20 [2%]). Its use was independently associated with anterior AMI location and hospitals with on-site angioplasty facilities, whereas advancing age, prior myocardial infarction (MI) and prior angioplasty or CABG were independently associated with its lower use. The three-year mortality of patients treated with ART was lower than in counterpart patients (22.0% vs. 31.4%, p = 0.0008), mainly as the result of 30-day to 3-year outcome (12.4% vs. 21.1%; hazard ratio = 0.73, 95% confidence interval [CI] 0.52 to 1.03). Independent predictors of long-term mortality were: age, heart failure on admission or during the hospitalization, ventricular tachycardia or fibrillation and diabetes. The outcome of patients not treated with ART differed according to the reason for the exclusion, where patients with contraindications experienced the highest three-year (50%) mortality rate. After ART, coronary angiography, angioplasty and CABG were performed in-hospital in 28%, 12% and 5% of patients, respectively. Their use was independently associated with recurrent infarction or ischemia, on-site catheterization or CABG facilities, non-Q-wave AMI and anterior infarct location. In the entire study population, and in patients with a non-Q-wave AMI, performance of ICP was associated with lower 30-day mortality (odds ratio [OR] = 0.53, 95% CI 0.25 to 0.98, and OR = 0.21, 0.03 to 0.84, respectively), but not thereafter.
This survey demonstrates the extent of implementation in daily practice of ART and ICP and their impact on early and long-term prognosis in an unselected population after AMI.
本调查旨在评估溶栓治疗、有创冠状动脉介入治疗（ICP）（血管造影、经皮腔内冠状动脉成形术和冠状动脉旁路移植术[CABG]）的使用频率、与其使用相关的变量，以及它们对急性心肌梗死（AMI）后早期（30天）和长期（3年）死亡率的影响。
关于AMI治疗临床试验结果在日常实践中的实施情况及其对AMI后未经选择的患者早期和长期预后的影响，可用数据很少。
1994年1月至2月在以色列运营的所有25个冠心病监护病房进行了一项基于社区的前瞻性全国性调查。
在999例连续的AMI患者中（72%为男性；平均年龄63±12岁），455例患者（46%）接受了急性再灌注治疗（ART）（435例患者[44%]接受溶栓治疗，20例[2%]接受直接血管成形术）。其使用与前壁AMI部位以及具备现场血管成形术设施的医院独立相关，而年龄增长、既往心肌梗死（MI）以及既往血管成形术或CABG与较低的使用率独立相关。接受ART治疗的患者三年死亡率低于未接受治疗的对应患者（22.0%对31.4%，p = 0.0008），主要是由于30天至3年的结果（12.4%对21.1%；风险比 = 0.73，95%置信区间[CI] 0.52至1.03）。长期死亡率的独立预测因素为：年龄、入院时或住院期间的心力衰竭、室性心动过速或颤动以及糖尿病。未接受ART治疗的患者结局因排除原因而异，有禁忌症的患者三年死亡率最高（50%）。接受ART治疗后，分别有28%、12%和5%的患者在住院期间进行了冠状动脉造影、血管成形术和CABG。它们的使用与复发性梗死或缺血、现场导管插入术或CABG设施、非Q波AMI以及前壁梗死部位独立相关。在整个研究人群以及非Q波AMI患者中，进行ICP与较低的30天死亡率相关（优势比[OR] = 0.53，95% CI 0.25至0.98，以及OR = 0.21，0.03至0.84），但之后则不然。
本调查显示了ART和ICP在日常实践中的实施程度及其对AMI后未经选择人群早期和长期预后的影响。
