Maynard C, Martin JS, Hallstrom AP, Weaver WD
Department of Medicine, School of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
J Thromb Thrombolysis. 1995;1(2):195-199. doi: 10.1007/BF01062578.
Background: Thrombolytic therapy has been shown to reduce mortality in select patients with acute myocardial infarction (AMI). The determinants of eligibility for therapy are changing as more information about the safety and efficacy of thrombolytic therapy is obtained. In the United States, there is some concern that thrombolytic therapy is underutilized, particularly in women and older patients. The purpose of this investigation is to examine change in the use of thrombolytic therapy in a single community from the years 1988 to 1992. Particular attention was paid to women and older patients. Methods: From January 1988 through December 1992, 9154 patients who developed AMI were admitted to coronary care units in 19 hospitals in the metropolitan Seattle area. The hospital records of each consecutive patient were reviewed, and key information was entered into the Myocardial Infarction Triage and Intervention database. Patients who developed AMI after hospital admission for another medical condition were excluded, as were the small numbers of patients with AMI complicated by cardiac arrest and resuscitation prior to hospital admission. This population-based study contains first admissions for AMI during the 5 year period of the registry. Results: The use of thrombolytic therapy in all patients increased from 18% to 24% (p <.0001) during the 5 year period; women (10-16%) and patients 75 years and older (3-10%) had proportionately greater increases in utilization. Despite widespread awareness of its importance, the median time from symptom onset to hospital arrival did not change during the 5 years, although there was a slight decrease in the time from hospital arrival to treatment with thrombolytic therapy. Conclusions: The change in use of thrombolytic therapy indicates that age and gender are less often used as exclusions for receiving thrombolytic therapy. It is possible that exclusionary criteria are being modified, with the result that this important treatment is being received by more people. The finding that there was no change in the time from acute symptom onset to hospital arrival requires intensive study. In particular, more needs to be known about patient decisionmaking, and innovative community interventions to reduce delay times must be evaluated.
溶栓治疗已被证明可降低部分急性心肌梗死（AMI）患者的死亡率。随着获得更多关于溶栓治疗安全性和有效性的信息，治疗的适用决定因素正在发生变化。在美国，有人担心溶栓治疗未得到充分利用，尤其是在女性和老年患者中。本研究的目的是考察1988年至1992年期间一个社区溶栓治疗使用情况的变化。特别关注了女性和老年患者。
从1988年1月至1992年12月，西雅图大都市地区19家医院的冠心病监护病房收治了9154例发生AMI的患者。对每位连续患者的医院记录进行了审查，并将关键信息录入心肌梗死分诊与干预数据库。因其他疾病入院后发生AMI的患者被排除，入院前发生AMI并伴有心脏骤停和复苏的少数患者也被排除。这项基于人群的研究包含了登记期间5年内AMI的首次入院病例。
在这5年期间，所有患者的溶栓治疗使用率从18%增至24%（p<.0001）；女性（从10%增至16%）和75岁及以上患者（从3%增至10%）的使用率增幅相对更大。尽管人们普遍意识到其重要性，但从症状发作到入院的中位时间在这5年中没有变化，不过从入院到接受溶栓治疗的时间略有缩短。
溶栓治疗使用情况的变化表明，年龄和性别较少被用作接受溶栓治疗的排除标准。排除标准可能正在修改，结果是更多的人正在接受这种重要治疗。急性症状发作到入院时间没有变化这一发现需要深入研究。特别是，需要更多了解患者的决策过程，并且必须评估减少延迟时间的创新性社区干预措施。
