Chin S P, Jeyaindran S, Azhari R, Wan Azman W A, Omar I, Robaayah Z, Sim K H
International Medical University, No 126, Jalan 19/155B, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
Med J Malaysia. 2008 Sep;63 Suppl C:29-36.
Coronary artery disease is one of the most rampant non-communicable diseases in the world. It begins indolently as a fatty streak in the lining of the artery that soon progresses to narrow the coronary arteries and impair myocardial perfusion. Often the atherosclerotic plaque ruptures and causes sudden thrombotic occlusion and acute ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI) or unstable angina (UA). This phenomenon is called acute coronary syndrome (ACS) and is the leading cause of death not only in Malaysia but also globally. In order for us to tackle this threat to the health of our nation we must arm ourselves with reliable and accurate information to assess current burden of disease resources available and success of current strategies. The acute coronary syndrome (ACS) registry is the flagship of the National Cardiovascular Disease Database (NCVD) and is the result of the dedicated and untiring efforts of doctors and nurses in both public and private medical institutions and hospitals around the country, ably guided and supported by the National Heart Association, the National Heart Foundation, the Clinical Research Centre and the Ministry of Health of Malaysia. Analyses of data collected throughout 2006 from 3422 patients with ACS admitted to the 12 tertiary cardiac centres and general hospitals spanning nine states in Malaysia in this first report has already revealed surprising results. Mean age of patients was 59 years while the most consistent risk factor for STEMI was active smoking. Utilization of medications was high generally. Thirty-day mortality for STEMI was 11%, for NSTEMI 8% and UA 4%. Thrombolysis (for STEMI only) reduced in-hospital and 30-day mortality by nearly 50%. Percutaneous coronary intervention or PCI also reduced 30-day mortality for patients with non-ST elevation MI and unstable angina. The strongest determinants of mortality appears to be Killip Class and age of the patient. Fewer women received thrombolysis or underwent PCI on same admission although women make up 25% of the cohort.
冠状动脉疾病是世界上最猖獗的非传染性疾病之一。它起初悄然以动脉内膜的脂肪条纹形式出现，很快就会发展为使冠状动脉变窄并损害心肌灌注。通常，动脉粥样硬化斑块会破裂，导致突然的血栓性闭塞以及急性ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）或不稳定型心绞痛（UA）。这种现象被称为急性冠状动脉综合征（ACS），不仅是马来西亚，也是全球范围内的主要死亡原因。为了应对这一对我国国民健康的威胁，我们必须掌握可靠且准确的信息，以评估当前的疾病负担、可用资源以及当前策略的成效。急性冠状动脉综合征（ACS）登记系统是国家心血管疾病数据库（NCVD）的旗舰项目，是全国公立和私立医疗机构及医院的医生和护士不懈努力的成果，在马来西亚国家心脏协会、国家心脏基金会、临床研究中心和卫生部的有力指导和支持下得以实现。在这份首份报告中，对2006年从马来西亚九个州的12家三级心脏中心和综合医院收治的3422例ACS患者收集的数据进行分析，已经得出了惊人的结果。患者的平均年龄为59岁，而STEMI最一致的危险因素是主动吸烟。药物的使用率总体较高。STEMI的30天死亡率为11%，NSTEMI为8%，UA为4%。溶栓治疗（仅用于STEMI）使住院期间和30天死亡率降低了近50%。经皮冠状动脉介入治疗（PCI）也降低了非ST段抬高型心肌梗死和不稳定型心绞痛患者的30天死亡率。死亡率的最强决定因素似乎是Killip分级和患者年龄。尽管女性占队列的25%，但在同一入院时接受溶栓治疗或PCI的女性较少。
