[急性冠状动脉综合征注册研究RECORD。患者特征及住院治疗结果]

[Registry of acute coronary syndromes RECORD. Characteristics of patients and results of inhospital treatment].

作者信息

Erlikh A D, Gratsianskiĭ N A

出版信息

Kardiologiia. 2009;49(7-8):4-12.

PMID:19656100

Abstract

PURPOSE

As contemporary information on real life management of hospitalized patients (pts) with acute coronary syndromes (ACS) in Russia is lacking we initiated limited ACS registry using no financial and no or minimal administrative support.

METHODS

REgistry of acute CORonary synDromes - RECORD is a participants-initiated internet based project which uses design and adapted documents of the ESC ACS Registry. Overall 18 hospitals from 14 cities of various Russian regions submitted required information. Centers were asked to include < or =50 consecutive pts admitted alive within 24 h after onset of symptoms during 1 month. Ten hospitals had possibilities to perform percutaneous coronary interventions (PCI).

RESULTS

From 11.01.2007 to 10.02, 2008 we included 796 pts (men 57.2%, age 31-93, mean 64.7+/-12.1, 25% >75 years) with ST elevation (STE) (n=246) and non-ST elevation (NSTE) (n=550) ACS. Invasive centers registered 65.4 and 46.2% of STEACS and NSTE ACS pts, respectively. STEACS. Median time from symptoms onset to hospitalization was 4.33 h (interquartile range 2.17-9.58 h). Primary reperfusion was used in 127 pts (51.6%) (thrombolysis in 79 [32.1%], primary PCI in 46 [18.7%], both in 2 pts). Median time from admission to start of thrombolysis was 0.33 h (interquartile range 0.17-0.53 h), from hospitalization to "start of PCI" (start of procedure, not to balloon) 1.5 h (interquartile range 0.83 - 4.08 h). Aspirin during hospitalization was given to 93.9, clopidogrel - to 44.9% (1/5 without loading dose) of pts. Average duration of hospitalization was 13.9 days. Hospital mortality was 16.7%. NSTEACS. Median time from symptoms onset to hospitalization was 7.42 h (interquartile range 3-23.75 h). ST depression more or equal 1mm on admission ECG was registered in 29.5%. Cardiac troponin was measured at least ones in 43.5% of pts, in 22.9% no markers of myocardial necrosis were assessed. PCI was used in 11.4%, coronary bypass surgery in 5.8% of pts. Anticoagulants were used in 84.9% of pts (in 73.3% - unfractionated heparin). In hospital aspirin was given to 92.9, clopidogrel - to 27.6% (29.6% without loading dose) of pts. Average hospital stay was 12.4 days. Discharge diagnosis was myocardial infarction in 32, unstable angina - in 51.1, stable angina - in 8.2, "noncardiac disease" - in 8.6% of pts. Hospital mortality was 2.7%.

CONCLUSION

Despite limited size RECORD represented wide scope of hospitals. It revealed obvious underuse of conventional treatments. In STEACS this was associated with high hospital mortality. In NSTEACS relatively satisfactory result could be explained by preponderance of unstable angina.

摘要

目的

由于缺乏俄罗斯住院急性冠状动脉综合征（ACS）患者现实生活管理的当代信息，我们在没有资金和行政支持或行政支持极少的情况下启动了有限的ACS登记。

方法

急性冠状动脉综合征登记（REgistry of acute CORonary synDromes - RECORD）是一个由参与者发起的基于互联网的项目，它采用了欧洲心脏病学会（ESC）ACS登记的设计和适配文件。俄罗斯不同地区14个城市的18家医院提交了所需信息。要求各中心纳入在症状发作后24小时内入院的连续≤50例存活患者，为期1个月。10家医院有能力进行经皮冠状动脉介入治疗（PCI）。

结果

从2007年1月11日至2008年2月10日，我们纳入了796例患者（男性占57.2%，年龄31 - 93岁，平均64.7±12.1岁，25%年龄＞75岁），包括ST段抬高（STE）型（n = 246）和非ST段抬高（NSTE）型（n = 550）ACS。有创治疗中心分别登记了STE - ACS和NSTE - ACS患者的65.4%和46.2%。STE - ACS。从症状发作到住院的中位时间为4.33小时（四分位间距2.17 - 9.58小时）。127例患者（51.6%）采用了早期再灌注治疗（79例[32.1%]进行了溶栓，46例[18.7%]进行了直接PCI，2例两者均采用）。从入院到开始溶栓的中位时间为0.33小时（四分位间距0.17 - 0.53小时），从住院到“开始PCI”（手术开始，而非球囊扩张）的时间为1.5小时（四分位间距0.83 - 4.08小时）。住院期间93.9%的患者使用了阿司匹林，44.9%的患者使用了氯吡格雷（1/5未给予负荷剂量）。平均住院时间为13.9天。医院死亡率为16.7%。NSTE - ACS。从症状发作到住院的中位时间为7.42小时（四分位间距3 - 23.75小时）。入院心电图ST段压低≥1mm的患者占29.5%。43.5%的患者至少检测了一次心肌肌钙蛋白，22.9%的患者未评估心肌坏死标志物。11.4%的患者采用了PCI，5.8%的患者进行了冠状动脉搭桥手术。84.9%的患者使用了抗凝剂（73.3%使用普通肝素）。住院期间92.9%的患者使用了阿司匹林，27.6%的患者使用了氯吡格雷（29.6%未给予负荷剂量）。平均住院时间为12.4天。出院诊断为心肌梗死的患者占32%，不稳定型心绞痛占51.1%，稳定型心绞痛占8.2%，“非心脏疾病”占8.6%。医院死亡率为2.7%。