Zahn R, Schiele R, Schneider S, Gitt A K, Heer T, Wienbergen H, Gottwik M, Altmann E, Grube R, Becker G, Baumgärtel B, Senges J
Herzzentrum Ludwigshafen.
Herz. 2000 Nov;25(7):667-75. doi: 10.1007/pl00001981.
In patients with acute myocardial infarction (AMI) admitted at hospitals without angioplasty facilities there are some subgroups of patients which seem to profit from a transfer to primary or acute angioplasty. However, current clinical practice at such hospitals is unknown. We analyzed the pooled data of the German acute myocardial infarction registries MITRA and the MIR. Angioplasty was not available at 221/271 hospitals (81.5%). Out of 14,487 patients with acute myocardial infarction admitted to these hospitals, 50.1% (7,259/14,487) received thrombolysis at the initial hospital and 3.6% (523/14,487) were transferred. Out of the transferred patients, 55.3% (289/523) were treated with primary angioplasty and 44.7% (234/523) received a combination of thrombolysis and angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998 (p for trend = 0.001). One hundred and four hospitals (47.1%) never transferred patients. Patients transferred for primary angioplasty (289 patients) were compared to patients treated with thrombolysis at the initial hospitals (7,259 patients). Multivariate analysis showed the following independent predictors for transfer of patients for primary angioplasty: contraindications for thrombolysis (OR = 17.9), a non-diagnostic first ECG (OR = 4.0), pre-hospital delay > 6 hours (OR = 2.5), unknown symptom onset of the acute myocardial infarction (OR = 2.0) and anterior wall acute myocardial infarction (OR = 1.6). Heart failure at admission was the only independent predictor not to transfer patients (OR = 0.40). In Germany only 47.1% of hospitals without angioplasty facilities transfer patients with acute myocardial infarction to primary or acute angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998. Contraindications for thrombolysis were the strongest predictor to transfer patients to primary angioplasty.
在没有血管成形术设备的医院收治的急性心肌梗死（AMI）患者中，有一些亚组患者似乎能从转至进行直接或急诊血管成形术的医院中获益。然而，此类医院目前的临床实践情况尚不清楚。我们分析了德国急性心肌梗死注册研究MITRA和MIR的汇总数据。271家医院中有221家（81.5%）没有血管成形术设备。在这些医院收治的14487例急性心肌梗死患者中，50.1%（7259/14487）在初始医院接受了溶栓治疗，3.6%（523/14487）被转院。在转院患者中，55.3%（289/523）接受了直接血管成形术治疗，44.7%（234/523）接受了溶栓与血管成形术联合治疗。转院患者的比例从1994年的1.1%增至1998年的5.5%（趋势p值=0.001）。104家医院（47.1%）从未转院过患者。将转至进行直接血管成形术治疗的患者（289例）与在初始医院接受溶栓治疗的患者（7259例）进行比较。多因素分析显示，以下因素是患者转至进行直接血管成形术的独立预测因素：溶栓治疗的禁忌证（比值比[OR]=17.9）、首次心电图未明确诊断（OR=4.0）、院前延误>6小时（OR=2.5）、急性心肌梗死症状发作时间不明（OR=2.0）以及前壁急性心肌梗死（OR=1.6）。入院时存在心力衰竭是不转院患者的唯一独立预测因素（OR=0.40）。在德国，没有血管成形术设备的医院中只有47.1%会将急性心肌梗死患者转至进行直接或急诊血管成形术治疗。转院患者的比例从1994年的1.1%增至1998年的5.5%。溶栓治疗的禁忌证是将患者转至进行直接血管成形术治疗的最强预测因素。
