Jackevicius Cynthia A, Alter David, Cox Jafna, Daly Paul, Goodman Shaun, Filate Woganee, Newman Alice, Tu Jack V
Pharmacy Department, University Health Network-Toronto General Hospital, Toronto, Ontario M5G 2C4.
Can J Cardiol. 2005 Feb;21(2):145-52.
Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber and geographical characteristics.
To describe the in-hospital use of reperfusion therapy for ST elevation MI (STEMI) and discharge use of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and statins in patients presenting with either STEMI or non-STEMI in Canada from 1999 to 2002.
Four Canadian registries (FASTRAK II, Canadian Acute Coronary Syndromes, Enhanced Feedback for Effective Cardiac Treatment and Improving Cardiovascular Outcomes in Nova Scotia) were used to identify patients with AMI in Canada and to measure in-hospital reperfusion and medication use. Use rates were compared by age, sex, time period and geographical area, according to available data.
Use rates for reperfusion in STEMI patients ranged from 60% to 70%, primarily representing fibrinolytic therapy. A delay in presentation to hospital after symptom onset represented an impediment to timely therapy, which was particularly pronounced for women and elderly patients. Overall, less than 50% of patients met the door-to-needle target of less than 30 min. Medication use rates at discharge increased from 1999/2000 to 2000/2001 across the different data sources: acetylsalicylic acid, 83% to 88%; beta-blockers, 74% to 89%; ACEIs, 54% to 67%; statins, 41% to 53%; and calcium antagonists, 21% to 32%.
Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.
急性心肌梗死（AMI）的治疗方法因患者、开处方者和地域特征而异。
描述1999年至2002年加拿大ST段抬高型心肌梗死（STEMI）患者住院期间再灌注治疗的使用情况以及STEMI或非STEMI患者出院时阿司匹林、β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）和他汀类药物的使用情况。
利用四个加拿大登记处（FASTRAK II、加拿大急性冠状动脉综合征、有效心脏治疗强化反馈和新斯科舍省改善心血管结局）来识别加拿大的AMI患者，并衡量住院期间的再灌注治疗和药物使用情况。根据现有数据，按年龄、性别、时间段和地理区域比较使用率。
STEMI患者的再灌注治疗使用率在60%至70%之间，主要为溶栓治疗。症状发作后到医院就诊的延迟是及时治疗的障碍，这在女性和老年患者中尤为明显。总体而言，不到50%的患者达到了门到针时间少于30分钟的目标。在不同数据源中，出院时的药物使用率从1999/2000年到2000/2001年有所增加：阿司匹林，从83%增至88%；β受体阻滞剂，从74%增至89%；ACEI，从54%增至67%；他汀类药物，从41%增至53%；钙拮抗剂，从21%增至32%。
随着时间的推移，加拿大和各省使用循证药物治疗AMI 的比例有所增加，尽管仍有改进空间。单一的综合数据源将为加拿大AMI的管理提供更好的见解。
