欧洲和地中海地区急性冠脉综合征患者的特征、治疗及预后的前瞻性调查；欧洲急性冠脉综合征心脏调查（欧洲心脏调查急性冠脉综合征）

A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS).

作者信息

Hasdai D, Behar S, Wallentin L, Danchin N, Gitt A K, Boersma E, Fioretti P M, Simoons M L, Battler A

机构信息

Rabin Medical Center, Petah Tikva, Israel.

出版信息

Eur Heart J. 2002 Aug;23(15):1190-201. doi: 10.1053/euhj.2002.3193.

DOI:10.1053/euhj.2002.3193

PMID:12127921

Abstract

AIMS

To better delineate the characteristics, treatments, and outcomes of patients with acute coronary syndromes (ACS) in representative countries across Europe and the Mediterranean basin, and to examine adherence to current guidelines.

METHODS AND RESULTS

We performed a prospective survey (103 hospitals, 25 countries) of 10484 patients with a discharge diagnosis of acute coronary syndromes. The initial diagnosis was ST elevation ACS in 42.3%, non-ST elevation ACS in 51.2%, and undetermined electrocardiogram ACS in 6.5%. The discharge diagnosis was Q wave myocardial infarction in 32.8%, non-Q wave myocardial infarction in 25.3%, and unstable angina in 41.9%. The use of aspirin, beta-blockers, angiotensin converting enzyme inhibitors, and heparins for patients with ST elevation ACS were 93.0%, 77.8%, 62.1%, and 86.8%, respectively, with corresponding rates of 88.5%, 76.6%, 55.8%, and 83.9% for non-ST elevation ACS patients. Coronary angiography, percutaneous coronary interventions, and coronary bypass surgery were performed in 56.3%, 40.4%, and 3.4% of ST elevation ACS patients, respectively, with corresponding rates of 52.0%, 25.4%, and 5.4% for non-ST elevation ACS patients. Among patients with ST elevation ACS, 55.8% received reperfusion treatment; 35.1% fibrinolytic therapy and 20.7% primary percutaneous coronary interventions. The in-hospital mortality of patients with ST elevation ACS was 7.0%, for non-ST elevation ACS 2.4%, and for undetermined electrocardiogram ACS 11.8%. At 30 days, mortality was 8.4%, 3.5%, and 13.3%, respectively.

CONCLUSIONS

This survey demonstrates the discordance between existing guidelines for ACS and current practice across a broad region in Europe and the Mediterranean basin and more extensively reflects the outcomes of ACS in real practice in this region.

摘要

目的

更好地描述欧洲和地中海盆地代表性国家急性冠脉综合征（ACS）患者的特征、治疗方法及预后，并检验对现行指南的遵循情况。

方法与结果

我们对10484例出院诊断为急性冠脉综合征的患者进行了一项前瞻性调查（涉及103家医院，25个国家）。初始诊断为ST段抬高型ACS的患者占42.3%，非ST段抬高型ACS的患者占51.2%，心电图未明确的ACS患者占6.5%。出院诊断为Q波心肌梗死的患者占32.8%，非Q波心肌梗死的患者占25.3%，不稳定型心绞痛的患者占41.9%。ST段抬高型ACS患者使用阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂和肝素的比例分别为93.0%、77.8%、62.1%和86.8%，非ST段抬高型ACS患者的相应比例分别为88.5%、76.6%、55.8%和83.9%。ST段抬高型ACS患者接受冠状动脉造影、经皮冠状动脉介入治疗和冠状动脉搭桥手术的比例分别为56.3%、40.4%和3.4%，非ST段抬高型ACS患者的相应比例分别为52.0%、25.4%和5.4%。在ST段抬高型ACS患者中，55.8%接受了再灌注治疗；35.1%接受了溶栓治疗，20.7%接受了直接经皮冠状动脉介入治疗。ST段抬高型ACS患者的院内死亡率为7.0%，非ST段抬高型ACS患者为2.4%，心电图未明确的ACS患者为11.8%。30天时，死亡率分别为8.4%、3.5%和13.3%。