澳大利亚 ST 段抬高型心肌梗死急性期再灌注治疗：ACACIA 注册研究结果。

Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: findings from the ACACIA registry.

机构信息

Flinders University, Adelaide, SA, Australia.

出版信息

Med J Aust. 2010 Nov 1;193(9):496-501. doi: 10.5694/j.1326-5377.2010.tb04031.x.

DOI:10.5694/j.1326-5377.2010.tb04031.x

PMID:21034381

Abstract

OBJECTIVE

To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia.

DESIGN, PARTICIPANTS AND SETTING: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007.

MAIN OUTCOME MEASURES

Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality.

RESULTS

In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. In hospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66).

CONCLUSION

Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

摘要

目的

描述澳大利亚 ST 段抬高型心肌梗死（STEMI）患者的当代治疗方法和结局。

设计、参与者和设置：对 2005 年 11 月 1 日至 2007 年 7 月 31 日期间疑似 STEMI 并参加澳大利亚急性冠状动脉综合征前瞻性审计的患者的数据进行观察性分析。

主要观察指标

与再灌注治疗的使用和及时使用再灌注治疗相关的因素，以及再灌注治疗对死亡率的影响。

结果

共纳入 755 例疑似 STEMI 患者。中位就诊时间为 105 分钟（IQR，60235 分钟）。66.9%（505/755）的患者接受了再灌注治疗，23.1%（174/755）的患者接受了及时再灌注治疗。在接受再灌注治疗的患者中，39.2%（198/505）接受了溶栓治疗，60.8%（307/505）接受了直接经皮冠状动脉介入治疗。心脏骤停（OR，2.83；P = 0.001）和在心脏病学部门治疗（OR，2.14；P = 0.02）与再灌注治疗的使用相关。就诊时心电图正常（OR，0.42；P = 0.01）、左束支传导阻滞（OR，0.18；P = 0.001）、急性肺水肿（OR，0.34；P < 0.01）、糖尿病史（OR，0.54；P < 0.01）和血管造影前病变>50%（OR，0.51；P = 0.001）与未使用再灌注治疗相关。院内死亡率为 4.0%（30/755），30 天死亡率为 4.8%（36/755），1 年死亡率为 7.8%（59/755）。接受任何类型的再灌注治疗与 12 个月死亡率降低相关（危险比[HR]，0.44；95%CI，0.250.78；P < 0.01）。及时再灌注与死亡率降低 78%相关（HR，0.22；P = 0.04）。与城市患者相比，农村患者的早期和晚期死亡率无显著差异（P = 0.66）。