Shamiss Yana, Khaykin Yaariv, Papastergiou John, Shufelt Katy, Madan Mina, Cohen Eric A, Paradiso-Hardy Fran L
Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada.
Can J Cardiol. 2003 Aug;19(9):1033-9.
Current guidelines for non-ST elevation acute coronary syndromes (NSTACS) recommend tailoring the intensity of therapeutic management according to the baseline risk of the patient. Although the clinical characteristics, risk stratification and therapeutic management of contemporary patients with NSTACS have been reported for other geographical regions, this information has not been documented from a Canadian perspective.
To describe the baseline clinical characteristics, therapeutic management and clinical outcomes of contemporary patients with NSTACS at a Canadian, tertiary care, teaching hospital, and to retrospectively risk stratify the patients with NSTACS according to the American College of Cardiology (ACC)/American Heart Association (AHA) and Thrombolysis in Myocardial Infarction (TIMI) risk guidelines to characterize management and outcomes according to the various risk classifications.
Baseline demographics, procedural variables and clinical outcome data were retrospectively collected in 380 patients with a diagnosis of NSTACS from July 1999 to July 2000. Patients were retrospectively categorized into high, intermediate and low risk categories using two classification schemes.
According to the ACC/AHA guidelines, 10.3% and 89.7% of patients were intermediate and high risk, respectively. Applying the TIMI risk score, 20.0%, 52.4% and 27.6% of patients were low, intermediate and high risk, respectively. The use of antithrombotic, acetylsalicylic acid and beta-blocker therapy was very high both in hospital and at discharge. Glycoprotein IIb/IIIa inhibitors, angiotensin-converting enzyme inhibitors and lipid lowering agents were all underutilized. The use of pharmacological therapies and cardiovascular interventions did not appear to correlate with the level of risk of the patient, at least within these classification schemes. Adverse clinical events in hospital and length of hospital stay increased as the risk level of the patients increased.
According to the ACC/AHA guidelines, patients with a discharge diagnosis of NSTACS in a nontrial setting are a high risk population, requiring prompt recognition and aggressive management. This study serves as an integral part of clinical practice to continually evaluate the quality of medical care.
目前非ST段抬高型急性冠脉综合征（NSTACS）的指南建议根据患者的基线风险调整治疗管理的强度。尽管其他地理区域已报道当代NSTACS患者的临床特征、风险分层及治疗管理情况，但尚未从加拿大的角度记录这些信息。
描述加拿大一家三级护理教学医院当代NSTACS患者的基线临床特征、治疗管理及临床结局，并根据美国心脏病学会（ACC）/美国心脏协会（AHA）和心肌梗死溶栓（TIMI）风险指南对NSTACS患者进行回顾性风险分层，以根据不同风险分类描述管理情况及结局。
回顾性收集1999年7月至2000年7月期间380例诊断为NSTACS患者的基线人口统计学资料、手术变量及临床结局数据。采用两种分类方案将患者回顾性分为高、中、低风险类别。
根据ACC/AHA指南，分别有10.3%和89.7%的患者为中风险和高风险。应用TIMI风险评分，分别有20.0%、52.4%和27.6%的患者为低、中、高风险。住院期间及出院时抗血栓、阿司匹林和β受体阻滞剂治疗的使用率都很高。糖蛋白IIb/IIIa抑制剂、血管紧张素转换酶抑制剂和降脂药物的使用均不足。至少在这些分类方案中，药物治疗和心血管介入治疗的使用似乎与患者的风险水平无关。随着患者风险水平的增加，住院期间不良临床事件及住院时间均增加。
根据ACC/AHA指南，在非试验环境中出院诊断为NSTACS的患者是高危人群，需要及时识别并积极管理。本研究是临床实践中持续评估医疗质量的重要组成部分。
