Awaida Jean-Pierre S, Dupuis Jocelyn, Théroux Pierre, Pelletier Guy, Joyal Michel, De Guise Pierre, Doucet Serge, Bilodeau Luc, Thibault Bernard, Tanguay Jean-Francois, Gallo Richard, Grégoire Jean, L'Allier Philippe L, Macle Laurent, Nigam Anil
Research Centre, Montreal Heart Institute, and Department of Medicine, University of Montreal, Quebec, Canada.
Can J Cardiol. 2006 Feb;22(2):121-4. doi: 10.1016/s0828-282x(06)70250-1.
Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited.
To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period.
A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed.
From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7.5 to 3.5 days. The mean age increased from 58.4 to 63.4 years, and the proportion of men remained stable at approximately 70%. The use of coronary angiograms increased from 49.8% to 81.1% in all patients, while fibrinolysis dropped to 0.4%. In-hospital mortality decreased from 9% to 1.5%. The percentage of overall instrumentation (arterial line, central venous catheter, temporary pacemaker, Swan-Ganz catheter and intra-aortic balloon pump) decreased from 38% to 8.1%. From 1995 to 2003, the proportion of stenting during percutaneous transluminal coronary angioplasty increased dramatically from 0% to 86%. In the past five years, surgical revascularization has remained stable at approximately 20% of all admissions. The proportion of patients discharged with a noncoronary chest pain diagnosis has remained constant at approximately 4%.
There has been a tremendous increase in efficiency, with an approximate doubling of the admissions turnover rate in a tertiary CCU. Patients with acute coronary syndromes are stratified faster and treated more invasively. Therapeutic advances are reflected by an almost linear 0.5% per year decrease in in-hospital mortality.
在专业心脏中心接受治疗的急性冠状动脉综合征患者的流行病学信息有限。
报告在一家三级冠心病监护病房（CCU）17年间收治患者的人口统计学特征、治疗情况及预后的演变。
分析了1986年4月至2003年3月在拥有21张床位的CCU收治的18719例患者的前瞻性数据库。
1986年至2003年，每年的入院人数从937例增加到1577例，而住院时间从7.5天降至3.5天。平均年龄从58.4岁增至63.4岁，男性比例保持稳定，约为70%。所有患者中冠状动脉造影的使用率从49.8%增至81.1%，而溶栓治疗降至0.4%。住院死亡率从9%降至1.5%。总体器械使用（动脉导管、中心静脉导管、临时起搏器、 Swan-Ganz导管和主动脉内球囊反搏）的比例从38%降至8.1%。1995年至2003年，经皮冠状动脉腔内血管成形术期间支架置入的比例从0%急剧增至86%。在过去五年中，手术血运重建一直稳定在所有入院患者的约20%。出院诊断为非冠状动脉性胸痛的患者比例一直保持在约4%。
效率有了巨大提高，三级CCU的入院周转率几乎翻了一番。急性冠状动脉综合征患者的分层更快，治疗更具侵入性。治疗进展表现为住院死亡率几乎呈每年0.5%的线性下降。
