Prabhakaran Dorairaj, Yusuf Salim, Mehta Shamir, Pogue Janice, Avezum Alvaro, Budaj Andrzej, Cerumzynski Leszek, Flather Marcus, Fox Keith, Hunt David, Lisheng Liu, Keltai Matyas, Parkhomenko Alexander, Pais Prem, Reddy Srinath, Ruda Mikhail, Hiquing Tan, Jun Zhu
McMaster University, Hamilton, Canada.
Indian Heart J. 2005 May-Jun;57(3):217-25.
Acute coronary syndrome continues to have significant long-term morbidity and mortality. This study sought to compare baseline characteristics, practice patterns and clinical outcomes for patients with non-ST elevation acute coronary syndrome from a broad range of low-, middle- and high-income countries.
We compared the data from a prospective registry of patients with non-ST elevation acute coronary syndrome involving 4615 patients from 65 centers in 8 low and middle income countries (OASIS registry 2) with those obtained from 7987 patients from 95 centers in 6 middle and high income countries (OASIS registry 1). Patients in the OASIS registry 2 were younger, were more often males and smokers, presented later to the hospital after symptom onset and had a lower prevalence of diabetes at admission [with the exception of India, which had the highest age-adjusted prevalence (39.1%)]. There were marked variations in the angiography and intervention rates during the hospital stay, but the uses of proven pharmacological therapies were comparable. The two-year mortality rates adjusted for baseline covariates ranged from 6.9% to 15%. Patients from China had the lowest two-year mortality rate (6.9%) and patients from India had the highest rate (15%). Combining the two registries, the covariate-adjusted rate of death or myocardial infarction did not differ across countries with in-hospital angiographic rates of > or = 50% (17.1%), 25-49% (16.7%) or < 25% (16.5%). However, the covariate-adjusted rates for subsequent myocardial infarction (7.6%, 9.2% and 10.8% respectively, p < 0.0001), refractory angina (21.3%, 27.7% and 35.4% respectively, p < 0.0001) and the composite of death, myocardial infarction or refractory angina (34.9%, 40.7% and 46.8% respectively, p < 0.0001) differed depending on the angiographic rates.
Among the participating countries there was a marked heterogeneity in patient characteristics, coronary interventions, resulting in differences in the two-year composite rates of death, myocardial infarction and refractory angina among patients admitted with non-ST elevation acute coronary syndrome.
急性冠状动脉综合征仍具有显著的长期发病率和死亡率。本研究旨在比较来自广泛的低收入、中等收入和高收入国家的非ST段抬高型急性冠状动脉综合征患者的基线特征、治疗模式和临床结局。
我们将来自8个低收入和中等收入国家65个中心的4615例非ST段抬高型急性冠状动脉综合征患者的前瞻性登记数据（OASIS登记2）与来自6个中等收入和高收入国家95个中心的7987例患者的数据（OASIS登记1）进行了比较。OASIS登记2中的患者更年轻，男性和吸烟者更多，症状发作后到医院就诊的时间更晚，入院时糖尿病患病率更低[印度除外，其年龄调整患病率最高（39.1%）]。住院期间血管造影和干预率存在显著差异，但已证实的药物治疗的使用情况相当。根据基线协变量调整后的两年死亡率在6.9%至15%之间。中国患者的两年死亡率最低（6.9%），印度患者的死亡率最高（15%）。将两个登记数据合并后，住院血管造影率≥50%（17.1%）、25 - 49%（16.7%）或<25%（16.5%）的国家，协变量调整后的死亡或心肌梗死发生率无差异。然而，根据血管造影率，后续心肌梗死的协变量调整率（分别为7.6%、9.2%和10.8%，p<0.0001）、难治性心绞痛的协变量调整率（分别为21.3%、27.7%和35.4%，p<0.0001）以及死亡、心肌梗死或难治性心绞痛的复合协变量调整率（分别为34.9%、40.7%和46.8%，p<0.0001）有所不同。
在参与研究的国家中，患者特征、冠状动脉干预存在显著异质性，导致非ST段抬高型急性冠状动脉综合征患者的两年死亡、心肌梗死和难治性心绞痛复合发生率存在差异。
