Perugini Enrica, Maggioni Aldo P, Boccanelli Alessandro, Di Pasquale Giuseppe
U.O. di Cardiologia, Ospedale di Bentivoglio (BO), Italy.
G Ital Cardiol (Rome). 2010 Oct;11(10):718-29.
Acute coronary syndromes (ACS) represent the most common cause of death in the western world and determine high morbidity. The objective of this review is to describe the epidemiology of ACS in the Italian setting, using administrative data, clinical surveys and registries. The prevalence of patients with myocardial infarction without persistent ST-segment elevation (NSTE) has increased in comparison with myocardial infarction with persistent ST-segment elevation patients. Females are about 30%, one third of patients is >75 years old, one quarter is affected by diabetes, patients with NSTE ACS show a higher risk profile. The mortality rate of patients with ACS has decreased over the last 10 years as a consequence of new therapeutic strategies. In order to offer primary coronary angioplasty to all ST-elevation myocardial infarction patients, a network between tertiary and peripheral hospitals is under development and implementation. Early experiences show a significant increase in the number of patients treated with reperfusion therapy and a decrease in mortality and morbidity. It has been demonstrated that management of NSTE patients, based on potent antithrombotic medication and coronary angioplasty, is primarily driven by resource availability rather than by clinical predictors of worse outcome. The reduction in recurrent ischemic events was obtained at the cost of an increased rate of major bleeding, which is associated with worse clinical outcomes. Therefore, it is essential the balance between the ischemic and hemorrhagic risk.
急性冠状动脉综合征（ACS）是西方世界最常见的死亡原因，且发病率很高。本综述的目的是利用行政数据、临床调查和登记处数据，描述意大利人群中ACS的流行病学情况。与持续性ST段抬高型心肌梗死患者相比，非持续性ST段抬高型（NSTE）心肌梗死患者的患病率有所增加。女性约占30%，三分之一的患者年龄>75岁，四分之一的患者患有糖尿病，NSTE ACS患者的风险特征更高。由于新的治疗策略，ACS患者的死亡率在过去10年中有所下降。为了向所有ST段抬高型心肌梗死患者提供直接冠状动脉成形术，三级医院和周边医院之间的网络正在建设和实施中。早期经验表明，接受再灌注治疗的患者数量显著增加，死亡率和发病率降低。已经证明，基于强效抗血栓药物和冠状动脉成形术的NSTE患者管理主要由资源可用性驱动，而非由预后较差的临床预测因素驱动。复发性缺血事件的减少是以大出血发生率增加为代价的，大出血与更差的临床结果相关。因此，缺血风险和出血风险之间的平衡至关重要。
