Yan Hongbing, Song Li, Yang Jingang, Sun Yihong, Hu Dayi
The 28th Division, Beijing Anzhen Hospital of the Capital University of Medical Science, Beijing, China.
Int J Cardiol. 2009 Jun 12;135(1):86-92. doi: 10.1016/j.ijcard.2008.09.002. Epub 2008 Oct 8.
To examine the association between pre-infarction angina (PA) and care-seeking behaviors and its effects on early reperfusion rates for patients with ST-elevation myocardial infarction (STEMI).
Between November 1, 2005 and December 31, 2006, a prospective, cross-sectional, and multicenter survey was conducted in 19 hospitals in Beijing and included consecutive patients with STEMI admitted within 12 h of onset of symptoms. Data were collected by structured interviews and medical records review.
PA within 48 h prior to the onset of the infarction occurred in 50.4% of the 498 patients. Prior to seeking care, patients in the PA group more frequently thought the symptoms would go away (61.8% vs. 38.5%, p < 0.001) and attempted some form of self-treatment (61.0% vs. 45.3%, p = 0.001) than the patients without PA (non-PA group). Median pre-hospital delay in the PA group was longer (118 vs. 103 min, p = 0.045) than in the non-PA group. The prevalence of ambulance use in the PA group was significantly lower than in the non-PA group (31.5% vs. 43.3%, p = 0.007). Multivariate analysis showed that the presence of PA was an independent predictor of pre-hospital delay >2 h (OR 1.863, 95% CI: 1.112-2.765, p = 0.013) and non-ambulance use (OR 1.724, 95% CI: 1.185-2.670, p = 0.003). In addition, patients in the PA group had a lower early reperfusion rate (74.7% vs. 83.3%, p = 0.027), mainly because of a lower incidence of primary percutaneous coronary intervention (58.6% vs. 67.9%, p = 0.042).
Presence of PA was associated with longer pre-hospital delay, significantly decreased use of ambulance, and lower early reperfusion rates among patients with STEMI.
探讨梗死前心绞痛（PA）与就医行为之间的关联及其对ST段抬高型心肌梗死（STEMI）患者早期再灌注率的影响。
2005年11月1日至2006年12月31日，在北京的19家医院进行了一项前瞻性、横断面多中心调查，纳入症状发作12小时内入院的连续性STEMI患者。通过结构化访谈和病历审查收集数据。
498例患者中，50.4%在梗死发作前48小时内发生PA。在就医前，PA组患者比无PA患者（非PA组）更频繁地认为症状会自行缓解（61.8%对38.5%，p<0.001），并尝试某种形式的自我治疗（61.0%对45.3%，p=0.001）。PA组的院前延迟中位数比非PA组长（118分钟对103分钟，p=0.045）。PA组使用救护车的比例显著低于非PA组（31.5%对43.3%，p=0.007）。多因素分析显示，PA的存在是院前延迟>2小时（比值比1.863，95%可信区间：1.112-2.765，p=0.013）和未使用救护车（比值比1.724，95%可信区间：1.185-2.670，p=0.003）的独立预测因素。此外，PA组患者的早期再灌注率较低（74.7%对83.3%，p=0.027），主要是因为直接经皮冠状动脉介入治疗的发生率较低（58.6%对67.9%，p=0.042）。
PA的存在与STEMI患者较长的院前延迟、救护车使用显著减少及较低的早期再灌注率相关。
