社区医院急性心肌梗死患者中血管紧张素转换酶抑制剂的应用。密歇根州立大学机构间协作心脏（MICH）研究小组。

The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Michigan State University Inter-Institutional Collaborative Heart (MICH) Study Group.

作者信息

Dwamena F C, El-Tamimi H, Watson R E, Kroll J, Stein A D, McLane A, Holmes-Rovner M, McIntosh B, Kupersmith J

机构信息

Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, USA.

出版信息

Clin Cardiol. 2000 May;23(5):341-6. doi: 10.1002/clc.4960230507.

DOI:10.1002/clc.4960230507

PMID:10803442

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654886/

Abstract

BACKGROUND

Previous studies documenting underutilization of angiotensin-converting enzyme inhibitors (ACEIs) in acute myocardial infarction (AMI) have been limited to Medicare populations.

HYPOTHESIS

This study examines ACEI prescription rates and predictors in a community sample of hospitalized patients with AMI.

METHODS

The charts of 1163 community patients with AMI, prospectively identified at admission between January 1, 1994, and April 30, 1995, were reviewed.

RESULTS

Only 64 of 158 (40%) patients considered ideal candidates for ACEI prescription were discharged with a prescription for an ACEI. In a multivariate logistic regression model, prior ACEI utilization [adjusted odds ration (OR) = 3.26; 95% confidence interval (CI) = 2.05-5.20], presence of congestive heart failure (OR = 2.33; CI = 1.50-3.61) and black race (OR = 2.20; CI = 1.34-3.64) were identified as positive predictors of ACEI prescription. Conversely, lack of left ventricular ejection fraction (LVEF) measurement (OR = 0.46; CI = 0.28-0.75), LVEF > 40 ( OR = 0.27; CI = 0.18-0.40), and acute renal failure (OR = 0.08; CI = 0.01-0.44) were negative predictors. Women were also less likely to be discharged with an ACEI prescription (OR = 0.71; CI = 0.48-1.05). Furthermore, women were significantly less likely to have LVEF measured prior to discharge than were males (77 vs. 85%, p = 0.001).

CONCLUSION

This study underscores the need for improvement in the utilization of ACEI in eligible patients with AMI. It also identifies opportunities for improvement in prescription rates, especially in women.

摘要

背景

先前关于急性心肌梗死（AMI）患者中血管紧张素转换酶抑制剂（ACEI）使用不足的研究仅限于医疗保险人群。

假设

本研究调查了社区中住院AMI患者的ACEI处方率及预测因素。

方法

回顾了1994年1月1日至1995年4月30日期间前瞻性确定的1163例社区AMI患者的病历。

结果

在被认为是ACEI处方理想人选的158例患者中，只有64例（40%）出院时开具了ACEI处方。在多因素逻辑回归模型中，既往使用过ACEI（调整优势比[OR]=3.26；95%置信区间[CI]=2.05 - 5.20）、存在充血性心力衰竭（OR = 2.33；CI = 1.50 - 3.61）和黑人种族（OR = 2.20；CI = 1.34 - 3.64）被确定为ACEI处方的阳性预测因素。相反，未进行左心室射血分数（LVEF）测量（OR = 0.46；CI = 0.28 - 0.75）、LVEF>40（OR = 0.27；CI = 0.18 - 0.40）和急性肾衰竭（OR = 0.08；CI = 0.01 - 0.44）是阴性预测因素。女性出院时开具ACEI处方的可能性也较小（OR = 0.71；CI = 0.48 - 1.05）。此外，女性出院前进行LVEF测量的可能性明显低于男性（77%对85%，p = 0.001）。