采用不同治疗策略的ST段抬高型心肌梗死患者的短期和长期死亡率。来自2002年大波兰地区注册研究（WIRE注册研究）的结果。

Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with different therapeutic strategies. Results from WIelkopolska REgional 2002 Registry (WIRE Registry).

作者信息

Grajek Stefan, Lesiak Maciej, Araszkiewicz Aleksander, Pyda Małgorzata, Skorupski Włodzimierz, Grygier Marek, Mitkowski Przemysław, Prech Marek, Baszko Artur, Janus Magdalena, Breborowicz Piotr, Rzeźniczak Janusz, Tarchalski Janusz, Główka Andrzej, Cieśliński Andrzej

机构信息

1st Department of Cardiology, Pozan University of Medical Science, Poznan, Poland.

出版信息

Kardiol Pol. 2008 Feb;66(2):154-63; discussion 164-5.

PMID:18344153

Abstract

BACKGROUND

Although primary coronary angioplasty seems to be the best treatment in acute myocardial infarction (MI), thrombolytic therapy still remains the most common reperfusion strategy particularly in smaller centers. Nowadays, different regional networks are developed to improve the treatment of patients with MI.

AIM

To analyse the effects of different therapeutic strategies on 30-day and long-term mortality (median time 18.3 months) after ST-elevation MI (STEMI) in a population of 3 350 000 people from the Wielkopolska Region.

METHODS

In 2002, 3780 patients with STEMI entered the registry. Complete data were available for 3564 (94.3%) patients. Depending on therapeutic strategies, patients were divided into five groups: the PCI group--direct percutaneous coronary angioplasty (PCI) in small cathlab, 'selected patients', n=381 (10.7%); the PA group--aged <70, treated with tissue plasminogen activator (rt-PA) up to 4 hours from the onset of chest pain, n=479 (13.4%); the IS group - invasive strategy in every patient, 24-hour duty, setting of unselected patients with STEMI, n=989 (27.7%); the SK group--patients receiving standard streptokinase treatment up to 12 hours from the onset of chest pain, n=584 (16.4%); the NR group--no reperfusion therapy, n=1131 (31.7%).

RESULTS

The 30-day mortality rate in the groups above was: 3.15, 4.38, 4.54, 9.25, and 12.5% respectively (p <0.001). Long-term mortality rate was: 4.2, 9.4, 9.4, 14.4, and 18.50% respectively (p <0.001). The rate of urgent PCI in the PA group was 25% and in the SK group--11% (p <0.001).

CONCLUSIONS

Treatment with rt-PA in patients under 70 years of age and up to 4 hours from pain onset may be an alternative to an invasive strategy. However, a quarter of those patients require urgent PCI. In long-term observation the mortality benefit can be clearly seen only in patients with early PCI.

摘要

背景

尽管直接冠状动脉血管成形术似乎是急性心肌梗死（MI）的最佳治疗方法，但溶栓治疗仍然是最常用的再灌注策略，尤其是在较小的医疗中心。如今，不同的区域网络已建立起来以改善MI患者的治疗。

目的

分析不同治疗策略对大波兰地区335万人群中ST段抬高型心肌梗死（STEMI）患者30天及长期死亡率（中位时间18.3个月）的影响。

方法

2002年，3780例STEMI患者进入登记系统。3564例（94.3%）患者有完整数据。根据治疗策略，患者被分为五组：PCI组——在小型导管室对“选定患者”进行直接经皮冠状动脉血管成形术（PCI），n = 381例（10.7%）；PA组——年龄<70岁，胸痛发作4小时内接受组织纤溶酶原激活剂（rt-PA）治疗，n = 479例（13.4%）；IS组——对所有患者采用侵入性策略，24小时值班，针对未选定的STEMI患者，n = 989例（27.7%）；SK组——胸痛发作12小时内接受标准链激酶治疗的患者，n = 584例（16.4%）；NR组——未进行再灌注治疗，n = 1131例（31.7%）。