波兰西波美拉尼亚省急性ST段抬高型心肌梗死的治疗。直接冠状动脉介入治疗与溶栓治疗的比较。

Treatment of acute ST-segment elevation myocardial infarction in West Pomerania province of Poland. Comparison between primary coronary intervention and thrombolytic therapy.

作者信息

Dryja Tomasz, Kornacewicz-Jach Zdzisława, Goracy Jarosław, Przybycień Krzysztof, Jodko Lukasz, Skowronek Andrzej, Kurowski Michał, Zinka Elzbieta

机构信息

Klinika Kardiologii Pomorskiej Akademii Medycznej, ul. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.

出版信息

Kardiol Pol. 2006 Jun;64(6):591-9; discussion 600-1.

DOI:

PMID:16810577

Abstract

INTRODUCTION

The majority of randomised studies on reperfusion in acute ST-segment elevation myocardial infarction (STEMI) show the advantage of primary percutaneous coronary intervention (PCI) over thrombolysis. However, the real world registers' data are not so unequivocal.

AIM

To evaluate the way acute STEMI is treated in West Pomerania province with emphasis on comparison of two reperfusion strategies, primary PCI vs thrombolytic therapy, in early and long-term perspective.

METHODS

Medical records of 961 STEMI patients treated between 1 January 2003 and 31 December 2003 were analysed. Data were collected from 3 centres with emergency cath lab availability and 15 regional sites. Long-term mortality was assessed based on regional provincial office database data.

RESULTS

69.9% of the study group received reperfusion (44.6% primary PCI, 25.3% thrombolysis). Mean age of patients was 62 (21 to 91) years. Patients referred for PCI were younger compared to the thrombolysis group. The percentage of females was similar in both groups. The majority of patients treated with PCI or thrombolysis were admitted to the hospital between 2 and 6 hours after symptoms--268 patients (46.4%). Seventy-nine patients (8.3%) died in the early (30-day) period. Mean age at time of death was 73 +/-8 years, whereas survivors' age was 61.5 (+/-12) years (p <0.001). Significantly higher mortality was observed in the conservative treatment group (12.7%) compared to patients treated with reperfusion. Forty-two out of 662 patients treated with PCI and thrombolysis died. The group of thrombolytic therapy tended to have higher mortality (7.9%) than PCI patients (5.5%); the difference however was not significant. Early mortality was influenced by older age (73.4 vs 59.5), female gender, low ejection fraction, and previous myocardial infarction. Current smoking has a positive effect on survival (mortality rate in smokers was 2.6%, in non-smokers 8.2%; p=0.0001). In long-term follow-up overall mortality in the entire group of 961 patients was 15.7% (12.1% in the reperfusion group). Long-term prognosis was worsened by older age, low ejection fraction, diabetes mellitus and non-smoking.

CONCLUSIONS

Treatment of STEMI in West Pomerania province is similar to that used in Europe and the USA. No significant difference in 30-day and long-term mortality between the two types of reperfusion were seen.

摘要

引言

大多数关于急性ST段抬高型心肌梗死（STEMI）再灌注治疗的随机研究表明，直接经皮冠状动脉介入治疗（PCI）优于溶栓治疗。然而，真实世界注册登记的数据并非如此明确。

目的

评估西波美拉尼亚省急性STEMI的治疗方式，重点是从早期和长期角度比较两种再灌注策略，即直接PCI与溶栓治疗。

方法

分析了2003年1月1日至2003年12月31日期间治疗的961例STEMI患者的病历。数据收集自3个配备急诊导管室的中心和15个地区站点。基于地区省级办公室数据库数据评估长期死亡率。

结果

研究组中69.9%的患者接受了再灌注治疗（44.6%接受直接PCI，25.3%接受溶栓治疗）。患者的平均年龄为62岁（21至91岁）。与溶栓组相比，接受PCI治疗的患者更年轻。两组中女性的比例相似。大多数接受PCI或溶栓治疗的患者在症状出现后2至6小时入院——268例患者（46.4%）。79例患者（8.3%）在早期（30天）死亡。死亡时的平均年龄为73±8岁，而存活者的年龄为61.5（±12）岁（p<0.001）。与接受再灌注治疗的患者相比，保守治疗组的死亡率显著更高（12.7%）。在接受PCI和溶栓治疗的662例患者中，42例死亡。溶栓治疗组的死亡率（7.9%）倾向于高于PCI患者（5.5%）；然而，差异不显著。早期死亡率受年龄较大（73.4岁对59.5岁）、女性性别、低射血分数和既往心肌梗死影响。当前吸烟对生存有积极影响（吸烟者的死亡率为2.6%，非吸烟者为8.2%；p=0.0001）。在长期随访中，961例患者的全组总死亡率为15.7%（再灌注组为12.1%）。年龄较大、低射血分数、糖尿病和不吸烟会使长期预后恶化。