Gottwik M, Zahn R, Schiele R, Schneider S, Gitt A K, Fraunberger L, Bossaller C, Glunz H G, Altmann E, Rosahl W, Senges J
The Städtisches Klinikum, Nürnberg, Germany.
Eur Heart J. 2001 Oct;22(19):1794-801. doi: 10.1053/euhj.2001.2630.
The specialty of the admitting physician may influence treatment and outcome in patients with acute myocardial infarction.
The pooled data of three German acute myocardial infarction registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) 1+2 studies and the Myocardial Infarction Registry (MIR) were analysed. Patients admitted to hospitals with departments of cardiology were compared to hospitals without such departments. A total of 24 814 acute myocardial infarction patients were included, 9020 (36%) patients at 91 (29.8%) hospitals with departments of cardiology and 15 794 (64%) at 214 (70.2%) hospitals without cardiology departments. There were only minor differences in patient characteristics and prevalence of concomitant diseases between the two types of hospital. The first electrocardiogram was more often diagnostic at hospitals with cardiology departments (71.8% vs 66.5%, P<0.001). Reperfusion therapy and adjunctive medical therapy, such as aspirin, beta-blockers and ACE-inhibitors were used more often at cardiology departments (all P -values <0.001), even after adjustment for confounding parameters. Treatment improved at both types of hospital over time. Admission to a hospital with a department of cardiology was independently associated with a lower hospital mortality (14.2% vs 15.4%, adjusted OR=0.91; 95%CI: 0.83-0.99). Additional logistic regression models showed that the higher use of reperfusion therapy and recommended concomitant medical therapy was responsible for most of the survival benefit at such hospitals.
Treatment of acute myocardial infarction patients at hospitals with departments of cardiology was independently associated with a higher use of recommended therapy and a lower hospital mortality compared to hospitals without such departments.
收治医生的专业可能会影响急性心肌梗死患者的治疗及预后。
分析了三个德国急性心肌梗死注册研究的汇总数据：急性心肌梗死最大个体化治疗（MITRA）1+2研究以及心肌梗死注册研究（MIR）。将入住设有心脏病科的医院的患者与未设心脏病科的医院的患者进行比较。共纳入24814例急性心肌梗死患者，其中9020例（36%）患者在91家（29.8%）设有心脏病科的医院，15794例（64%）患者在214家（70.2%）未设心脏病科的医院。两类医院在患者特征及合并疾病患病率方面仅有细微差异。在设有心脏病科的医院，首次心电图检查更常具有诊断价值（71.8%对66.5%，P<0.001）。即使在对混杂参数进行调整后，再灌注治疗以及辅助药物治疗，如阿司匹林、β受体阻滞剂和血管紧张素转换酶抑制剂，在心脏病科的使用频率也更高（所有P值均<0.001）。随着时间推移，两类医院的治疗均有所改善。入住设有心脏病科的医院与较低的医院死亡率独立相关（14.2%对15.4%，调整后的OR=0.91；95%CI：0.83-0.99）。额外的逻辑回归模型显示，在这类医院，再灌注治疗及推荐的辅助药物治疗的较高使用率是大部分生存获益的原因。
与未设心脏病科的医院相比，在设有心脏病科的医院治疗急性心肌梗死患者与推荐治疗的更高使用率及更低的医院死亡率独立相关。
