东伦敦急性心肌梗死情况的变化：再灌注时代管理与结局趋势的前瞻性队列研究

Changing face of acute myocardial infarction in east London: a prospective cohort study of trends in management and outcome in the reperfusion era.

作者信息

Barakat K, Wilkinson P, Suliman A, Ranjadayalan K, Timmis A

机构信息

Department of Cardiology Royal Hospitals Trust, London, UK.

出版信息

J Cardiovasc Risk. 2001 Feb;8(1):21-9. doi: 10.1177/174182670100800104.

DOI:10.1177/174182670100800104

PMID:11234723

Abstract

AIMS

To define the trends in management and outcome of acute myocardial infarction over the first decade since the widespread adoption of thrombolytic therapy.

METHODS

Prospective cohort study of 1737 consecutive patients with acute myocardial infarction admitted for coronary care between January 1988 and December 1997.

RESULTS

Trend analysis with comparison of early (1988-1992) and late (1993-1997) cohorts showed significant increments in median age (interquartile range) from 62 (54-70) to 64 (55-72) years (P < 0.01) but the proportion of smokers fell from 72.7% to 65.8% (P < 0.01). The proportion of patients receiving thrombolytic therapy increased from 70% to 78.1% (P < 0.01) as median door-to-needle times fell significantly from 92 (60-145) to 68 (45-123) minutes (P < 0.01). The proportion of patients discharged on aspirin increased from 88.2% to 95.9% (P < 0.01), -blockers increased from 37.4% to 45.8% (P < 0.01), and angiotensin converting enzyme inhibitors increased from 12.4% to 35.7% (P < 0.01). Median hospital stay fell from 9 (7-11) to 6 (5-9) days (P < 0.0001). Although the severity of infarction declined, judged by reductions in the frequency of Q-wave development from 78.1% to 73.9% (P = 0.01) and peak CK from 1250 (569-2085) to 1004 (511-1722) IU/l, survival (95% confidence intervals) for the early and late cohorts did not change significantly either at 30 days [0.86 (0.83-0.88) vs. 0.85 (0.83-0.88)] or at 1 year [0.79 (0.76-0.81) vs 0.78 (0.76-0.81)].

CONCLUSION

The decade from 1988-1997 saw significant changes in the demographic characteristics and risk factor profiles of patients with acute myocardial infarction admitted for coronary care. We observed trends towards increasingly aggressive antithrombotic treatment and early discharge policies, with more patients being prescribed drugs for secondary prevention. The combined effects of these complex changes on the outcome of infarction defy simple analysis and there was no palpable change in short- and longer-term.

摘要

目的

明确自溶栓治疗广泛应用后的首个十年中急性心肌梗死的管理和预后趋势。

方法

对1988年1月至1997年12月期间因冠心病监护收治的1737例连续性急性心肌梗死患者进行前瞻性队列研究。

结果

对早期（1988 - 1992年）和晚期（1993 - 1997年）队列进行趋势分析并比较，结果显示中位年龄（四分位间距）从62（54 - 70）岁显著增至64（55 - 72）岁（P < 0.01），但吸烟者比例从72.7%降至65.8%（P < 0.01）。接受溶栓治疗的患者比例从70%增至78.1%（P < 0.01），同时中位门 - 针时间从92（60 - 145）分钟显著降至68（45 - 123）分钟（P < 0.01）。出院时服用阿司匹林的患者比例从88.2%增至95.9%（P < 0.01），服用β受体阻滞剂的患者比例从37.4%增至45.8%（P < 0.01），服用血管紧张素转换酶抑制剂的患者比例从12.4%增至35.7%（P < 0.01）。中位住院时间从9（7 - 11）天降至6（5 - 9）天（P < 0.0001）。尽管梗死严重程度有所下降，表现为Q波发生频率从78.1%降至73.9%（P = 0.01）以及肌酸激酶峰值从1250（569 - 2085）降至1004（511 - 1722）IU/L，但早期和晚期队列的生存率（95%置信区间）在30天时[0.86（0.83 - 0.88）对0.85（0.83 - 0.88）]或1年时[0.79（0.76 - 0.81）对0.78（0.76 - 0.81）]均无显著变化。