Balzi Daniela, Barchielli Alessandro, Santoro Giovanni Maria, Carrabba Nazario, Buiatti Eva, Giglioli Cristina, Valente Serafina, Baldereschi Giorgio, Del Bianco Laura, Monami Matteo, Gensini Gian Franco, Marchionni Niccolò
Epidemiology Unit, Azienda Sanitaria Firenze, Viale Michelangelo 41, 50125 Florence, Italy.
Intern Emerg Med. 2008 Jun;3(2):109-15. doi: 10.1007/s11739-008-0090-x. Epub 2008 Feb 14.
The Florence Acute Myocardial Infarction registry was a population-based, prospective study aimed at identifying the determinants of coronary reperfusion therapy [CRT, by primary coronary intervention (PCI) in more than 95% of cases] utilization and of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). The registry involved one teaching hospital with, and five district hospitals without PCI facilities. Overall, as many as 45.6% of 930 cases of STEMI did not receive any form of CRT. In multivariable analysis, the direct admission to the teaching hospital was the strongest positive predictor, whereas the time delay, older age, and chronic comorbid conditions were negative predictors of CRT utilization. Compared to conservative therapy, CRT was associated with a remarkably reduced 12-month mortality, after adjusting for age, chronic comorbidities and Killip class, which also were significantly associated with long-term prognosis. The higher crude mortality observed in women was accounted for by older age and other age-related factors. The improvement in prognosis with CRT was larger in older patients and/or in those with a greater burden of chronic comorbidity, who less frequently received CRT. These results suggest the need for interdisciplinary reassessing the adherence to therapeutic guidelines and the criteria adopted in the real clinical world to select patients for CRT during STEMI.
佛罗伦萨急性心肌梗死注册研究是一项基于人群的前瞻性研究，旨在确定冠状动脉再灌注治疗（CRT，95%以上的病例通过直接冠状动脉介入治疗[PCI]）的使用决定因素以及ST段抬高型心肌梗死（STEMI）患者的预后。该注册研究涉及一家有PCI设施的教学医院和五家没有PCI设施的地区医院。总体而言，930例STEMI患者中多达45.6%未接受任何形式的CRT。在多变量分析中，直接入住教学医院是最强的阳性预测因素，而时间延迟、高龄和慢性合并症是CRT使用的阴性预测因素。与保守治疗相比，在调整年龄、慢性合并症和Killip分级后，CRT与显著降低的12个月死亡率相关，这些因素也与长期预后显著相关。女性中观察到的较高粗死亡率是由年龄较大和其他与年龄相关的因素造成的。在老年患者和/或慢性合并症负担较重的患者中，CRT对预后的改善更大，而这些患者接受CRT的频率较低。这些结果表明，需要进行跨学科重新评估对治疗指南的遵守情况以及在现实临床中选择STEMI患者进行CRT时所采用的标准。
