Yan Andrew T, Tan Mary, Fitchett David, Chow Chi-Ming, Fowlis Ronald A, McAvinue Thomas G, Roe Matthew T, Peterson Eric D, Tu Jack V, Langer Anatoly, Goodman Shaun G
Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Am J Cardiol. 2004 Jul 1;94(1):25-9. doi: 10.1016/j.amjcard.2004.03.024.
The objective of this study was to determine the management and outcome of less [corrected] selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge. The Canadian Acute Coronary Syndromes Registry was a prospective observational study of patients admitted with suspected acute coronary syndromes. Data on demographic and clinical characteristics, in-hospital treatment, and outcomes were recorded. At 1 year, vital status, medication use, recurrent cardiac events, and procedures were determined by telephone contact. Of the 5,312 patients enrolled, 4,627 had a final diagnosis of acute coronary syndrome, with Q-wave myocardial infarction in 27.7%, non-Q-wave myocardial infarction in 33.2%, and unstable angina pectoris in 39.1%. During hospitalization, coronary angiography and revascularization were performed in 39.6% and 20.3% of patients, respectively. The in-hospital mortality rate was 2.4% overall. At discharge, 87.8%, 76.4%, 56.0%, and 54.8% of patients were prescribed aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents, respectively. Unadjusted 1-year mortality rates for hospital survivors were 6.5%, 10%, and 5.4% for those with Q-wave myocardial infarction, non-Q-wave myocardial infarction, and unstable angina pectoris groups, respectively (p <0.0001). This difference in mortality rate remained significant after adjusting for other prognosticators, whereas the use of coronary angiography and revascularization after discharge was similar across patients. At 1 year, fewer patients were maintained on aspirin and beta blockers, whereas the use of lipid-lowering therapy increased (all p <0.0001). Despite similar rates of coronary angiography and revascularization after discharge, patients with non-Q-wave myocardial infarction had worse outcomes at 1 year. Moreover, there was a significant opportunity to enhance the discharge and long-term use of evidence-based secondary prevention therapies.
本研究的目的是确定入选标准相对宽松的急性冠状动脉综合征患者在住院期间及出院后长达1年的管理情况和结局。加拿大急性冠状动脉综合征注册研究是一项对疑似急性冠状动脉综合征入院患者的前瞻性观察性研究。记录了人口统计学和临床特征、住院治疗情况及结局的数据。在1年时，通过电话联系确定生命状态、药物使用情况、复发性心脏事件及诊疗操作。在纳入的5312例患者中，4627例最终诊断为急性冠状动脉综合征，其中27.7%为Q波心肌梗死，33.2%为非Q波心肌梗死，39.1%为不稳定型心绞痛。住院期间，分别有39.6%和20.3%的患者接受了冠状动脉造影和血运重建治疗。总体住院死亡率为2.4%。出院时，分别有87.8%、76.4%、56.0%和54.8%的患者接受了阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂及降脂药物治疗。Q波心肌梗死、非Q波心肌梗死和不稳定型心绞痛组的医院幸存者未经调整的1年死亡率分别为6.5%、10%和5.4%（p<0.0001）。在对其他预后因素进行调整后，死亡率的这种差异仍然显著，而出院后冠状动脉造影和血运重建治疗的使用在患者中相似。在1年时，继续使用阿司匹林和β受体阻滞剂的患者减少，而降脂治疗的使用增加（所有p<0.0001）。尽管出院后冠状动脉造影和血运重建治疗的比例相似，但非Q波心肌梗死患者在1年时结局较差。此外，在加强出院时及长期使用循证二级预防治疗方面仍有很大机会。
