Sawaya J I, Jazra C, Farhat F, Alam S, Eid E V, Sabra R
Division of Cardiology, American University of Beirut (AUB), Lebanon.
J Med Liban. 2000 Mar-Apr;48(2):63-9.
To study the incidence of in-hospital mortality following acute myocardial infarction in Lebanon, and its relationship to demographic, clinical variables, and therapeutic strategies.
PATIENTS & METHODS: Consecutive admissions due to myocardial infarction to 18 medical centers in various regions of Lebanon were entered into the Lebanese Myocardial Infarction Study, conducted between January and July 1996. Information was obtained on age, gender, time of onset of symptoms, delay to hospital arrival, mode of transport, and coronary risk factor analysis. The patients were followed up in hospital for analysis of modes of therapy, complications and mortality.
There were 44 in-hospital deaths among the 433 admissions (10.2%), which is a rate lower than those previously reported from Lebanon. Less than half the patients presented within 6 hours of onset of symptoms and only 28% received thrombolytic therapy. The mortality rate was higher in older age groups, those presenting with cardiogenic shock or pulmonary edema, those with a history of angina, infarction or heart failure, and those who developed recurrent ischemia or infarction during their hospital stay. Furthermore, occurrence of ventricular arrhythmias, mechanical complications, congestive heart failure and left bundle branch block was associated with a higher mortality rate. Treatment with angiotensin converting enzyme inhibitors, beta-blockers, aspirin, heparin, nitrates and thrombolytics significantly reduced mortality rates.
The results reveal improvement in the survival of patients after acute myocardial infarction to values similar to those reported from Western countries. Further effort should be expended to enhance early arrival to the hospital, increased thrombolytic therapy and to implement treatment strategies supported by large clinical trials such as use of aspirin, ACE inhibitors and beta-blockers.
研究黎巴嫩急性心肌梗死后住院死亡率及其与人口统计学、临床变量和治疗策略的关系。
1996年1月至7月在黎巴嫩各地18个医疗中心连续收治的因心肌梗死入院的患者纳入黎巴嫩心肌梗死研究。收集了患者的年龄、性别、症状发作时间、延迟入院时间、交通方式以及冠状动脉危险因素分析等信息。对患者进行住院随访，分析治疗方式、并发症和死亡率。
433例入院患者中有44例住院死亡（10.2%），这一比例低于黎巴嫩此前报告的比例。不到一半的患者在症状发作后6小时内就诊，只有28%的患者接受了溶栓治疗。老年患者、出现心源性休克或肺水肿的患者、有心绞痛、梗死或心力衰竭病史的患者以及住院期间发生反复缺血或梗死的患者死亡率较高。此外，室性心律失常、机械性并发症、充血性心力衰竭和左束支传导阻滞的发生与较高的死亡率相关。使用血管紧张素转换酶抑制剂、β受体阻滞剂、阿司匹林、肝素、硝酸盐和溶栓药物治疗可显著降低死亡率。
结果显示急性心肌梗死后患者的生存率有所提高，达到了与西方国家报告相似的水平。应进一步努力提高患者早期入院率，增加溶栓治疗，并实施大型临床试验支持的治疗策略，如使用阿司匹林、血管紧张素转换酶抑制剂和β受体阻滞剂。
