[院际网络背景下再灌注策略对ST段抬高型心肌梗死患者院内结局的影响：来自前瞻性VENERE注册研究（VENeto急性心肌梗死注册研究）的数据]

[Impact of reperfusion strategies on in-hospital outcome in ST-elevation myocardial infarction in a context of interhospital network: data from the prospective VENERE registry (VENEto acute myocardial infarction REgistry].

作者信息

Di Pede Francesco, Olivari Zoran, Schievano Elena, Spolaore Paolo, Cacciavillani Luisa, La Vecchia Luigi, Bruni Andrea, Zuin Guerrino, Franco Gian Franco, Palatini Osvaldo, Morando Giorgio, Tinto Monica, Rossi Maurizio, Guarnerio Mauro

机构信息

Dipartimento Cardiovascolare, Ospedale Umberto I, Mestre (VE).

出版信息

Ital Heart J Suppl. 2005 Dec;6(12):804-11.

PMID:16444924

Abstract

BACKGROUND

Primary angioplasty (pPCI) is the most effective reperfusion treatment of acute ST-elevation myocardial infarction (STEMI), but logistic- and organization-related problems could affect the outcome. The aim of this study was to investigate the in-hospital outcome according to reperfusion strategy in the Veneto Region cardiology network.

METHODS

A treatment protocol, aimed to treat patients with high-risk STEMI by pPCI on-site or after transport, was developed and shared by the majority of cardiology departments in the Veneto Region. Data of all consecutive patients with STEMI were prospectively recorded during a 6-month period.

RESULTS

999 patients with symptom onset < 12 hours were admitted to the 28 participating hospitals: 860 were treated on-site and 139 were transferred from the admitting hospital to an interventional center for PCI. Overall, 82% of patients were treated with reperfusion therapy. Ten patients died immediately before any treatment could be initiated. In 170 patients who did not receive any reperfusion treatment, in 302 patients who received fibrinolysis (and eventually rescue PCI) and in 517 patients sent to pPCI, the following in-hospital outcome was observed respectively: mortality rate 10, 6.95 and 6.57%; reinfarction rate 0.6, 1 and 0.4%; incidence of stroke 1.7, 1.4 and 0.9%; the need for urgent revascularization procedure 6.5, 10 and 2.3%. After adjustment for confounding variables, the in-hospital occurrence of the combined events was significantly lower in patients treated with pP-CI (odds ratio 0.33, confidence interval 0.20-0.53, p < 0.01) as well as a trend for a reduced in-hospital mortality was observed (odds ratio 0.51, confidence interval 0.26-1.03, p = 0.06).

CONCLUSIONS

In the VENERE registry, patients treated with pPCI had a better in-hospital outcome as compared to those treated with fibrinolytic strategy.

摘要

背景

直接经皮冠状动脉介入治疗（pPCI）是急性ST段抬高型心肌梗死（STEMI）最有效的再灌注治疗方法，但后勤和组织相关问题可能会影响治疗结果。本研究旨在调查威尼托地区心脏病学网络中根据再灌注策略得出的院内治疗结果。

方法

制定了一项治疗方案，旨在通过现场或转运后的pPCI治疗高危STEMI患者，并由威尼托地区的大多数心脏病学部门共享。在6个月期间前瞻性记录所有连续的STEMI患者的数据。

结果

999例症状发作时间<12小时的患者被收治入28家参与研究的医院：860例在现场接受治疗，139例从收治医院转至介入中心进行PCI。总体而言，82%的患者接受了再灌注治疗。10例患者在任何治疗开始前即刻死亡。在170例未接受任何再灌注治疗的患者、302例接受纤溶治疗（最终进行补救性PCI）的患者和517例接受pPCI治疗的患者中，分别观察到以下院内治疗结果：死亡率分别为10%、6.95%和6.57%；再梗死率分别为0.6%、1%和0.4%；卒中发生率分别为1.7%、1.4%和0.9%；紧急血管重建手术需求率分别为6.5%、10%和2.3%。在对混杂变量进行调整后，接受pPCI治疗的患者联合事件的院内发生率显著更低（比值比0.33，置信区间0.20 - 0.53，p < 0.01），并且观察到院内死亡率有降低趋势（比值比0.51，置信区间0.26 - 1.03，p = 0.06）。