Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
JAMA. 2011 Apr 27;305(16):1677-84. doi: 10.1001/jama.2011.522.
Only limited information is available on the speed of implementation of new evidence-based and guideline-recommended treatments and its association with survival in real life health care of patients with ST-elevation myocardial infarction (STEMI).
To describe the adoption of new treatments and the related chances of short- and long-term survival in consecutive patients with STEMI in a single country over a 12-year period.
DESIGN, SETTING, AND PARTICIPANTS: The Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA) records baseline characteristics, treatments, and outcome of consecutive patients with acute coronary syndrome admitted to almost all hospitals in Sweden. This study includes 61,238 patients with a first-time diagnosis of STEMI between 1996 and 2007.
Estimated and crude proportions of patients treated with different medications and invasive procedures and mortality over time.
Of evidence-based treatments, reperfusion increased from 66% (95%, confidence interval [CI], 52%-79%) to 79% (95% CI, 69%-89%; P < .001), primary percutaneous coronary intervention from 12% (95% CI, 11%-14%) to 61% (95% CI, 45%-77%; P < .001), and revascularization from 10% (96% CI, 6%-14%) to 84% (95% CI, 73%-95%; P < .001). The use of aspirin, clopidogrel, β-blockers, statins, and angiotensin-converting enzyme (ACE) inhibitors all increased: clopidogrel from 0% to 82% (95% CI, 69%-95%; P < .001), statins from 23% (95% CI, 12%-33%) to 83% (95% CI, 75%-91%; P < .001), and ACE inhibitor or angiotensin II receptor blockers from 39% (95% CI, 26%-52%) to 69% (95% CI, 58%-70%; P < .001). The estimated in-hospital, 30-day and 1-year mortality decreased from 12.5% (95% CI, 4.3%-20.6%) to 7.2% (95% CI, 1.7%-12.6%; P < .001); from 15.0% (95% CI, 6.2%-23.7%) to 8.6% (95% CI, 2.7%-14.5%; P < .001); and from 21.0% (95% CI, 11.0%-30.9%) to 13.3% (95% CI, 6.0%-20.4%; P < .001), respectively. After adjustment, there was still a consistent trend with lower standardized mortality over the years. The 12-year survival analyses showed that the decrease of mortality was sustained over time.
In a Swedish registry of patients with STEMI, between 1996 and 2007, there was an increase in the prevalence of evidence-based treatments. During this same time, there was a decrease in 30-day and 1-year mortality that was sustained during long-term follow-up.
关于新的循证和指南推荐治疗方法的实施速度及其与 ST 段抬高型心肌梗死（STEMI）患者实际医疗保健中生存的关系，只有有限的信息可用。
描述在 12 年期间，在一个单一国家的连续 STEMI 患者中采用新治疗方法的情况及其与短期和长期生存的关系。
设计、地点和参与者：瑞典心脏重症监护入院登记（RIKS-HIA）记录了急性冠状动脉综合征患者的基线特征、治疗方法和结局，这些患者几乎来自瑞典所有的医院。本研究包括 1996 年至 2007 年间首次诊断为 STEMI 的 61238 例患者。
随时间推移，不同药物和介入治疗的估计和粗比例以及死亡率。
在循证治疗中，再灌注治疗从 66%（95%置信区间[CI]，52%-79%）增加到 79%（95%CI，69%-89%；P<.001），直接经皮冠状动脉介入治疗从 12%（95%CI，11%-14%）增加到 61%（95%CI，45%-77%；P<.001），血管重建从 10%（96%CI，6%-14%）增加到 84%（95%CI，73%-95%；P<.001）。阿司匹林、氯吡格雷、β受体阻滞剂、他汀类药物和血管紧张素转换酶（ACE）抑制剂的使用率均有所增加：氯吡格雷从 0%增加到 82%（95%CI，69%-95%；P<.001），他汀类药物从 23%（95%CI，12%-33%）增加到 83%（95%CI，75%-91%；P<.001），ACE 抑制剂或血管紧张素 II 受体阻滞剂从 39%（95%CI，26%-52%）增加到 69%（95%CI，58%-70%；P<.001）。估计的院内、30 天和 1 年死亡率从 12.5%（95%CI，4.3%-20.6%）降至 7.2%（95%CI，1.7%-12.6%；P<.001）；从 15.0%（95%CI，6.2%-23.7%）降至 8.6%（95%CI，2.7%-14.5%；P<.001）；从 21.0%（95%CI，11.0%-30.9%）降至 13.3%（95%CI，6.0%-20.4%；P<.001）。调整后，标准化死亡率仍呈逐年下降趋势。12 年生存分析显示，死亡率的下降持续存在。
在瑞典 STEMI 患者注册中，1996 年至 2007 年间，采用循证治疗的比例有所增加。在此期间，30 天和 1 年死亡率下降，且在长期随访中持续下降。
