Université Libre de Bruxelles, Brussels, Belgium.
Eur J Prev Cardiol. 2012 Aug;19(4):738-45. doi: 10.1177/1741826711415707. Epub 2011 Jun 27.
BACKGROUND/OBJECTIVES: To describe the evolution of the therapeutic practices over 10 years of follow-up of acute myocardial infarction (AMI) in Charleroi and to analyse the factors influencing the choice of treatments and the mortality of these patients.
The Charleroi register of ischaemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium and is one of the very rare registers that allows identifying tendencies over 25 years. Analyses presented hereafter relate only patients in the 25-69-year age range over time from 1998 to 2007. The data were analysed in five periods of 2 years. Treatment evolutions over time were analysed using chi-squared tests for trend and logistic regression analyses identify factors influencing the type of treatment.
The present study shows a marked increase in the utilization of percutaneous transluminal coronary angioplasty (PTCA) between 1998-1999 and 2006-2007. The use of thrombolytic agents on approximately one-third of the patients treated remained fairly stable between 1998 and 2007. A lower proportion of patients with a history of AMI received thrombolytic agents. Thrombolysis seems beneficial for men and without effect for women. The use of β-blockers continued to increase until the 2000-2001 period and remained fairly stable for the two following periods. 42% of patients were administered three medications (angiotensin-converting enzyme inhibitors, antiplatelet drugs, and β-blockers). Association of PTCA with antiplatelet drugs, β-blockers, and thrombolysis was observed for 58.7, 50.6, and 25.7%, respectively. These associations were still observed after adjustment for gender, age, and comorbidity. The factors associated with fatality were specifically old-aged patients, antecedents of diabetes, hypercholesterolaemia and oral antiplatelet drugs, and β-blockers therapies and PTCA.
The evolution of the therapeutic data on AMI in this register confirms the use and the efficacy of thrombolytic therapy. PTCA becomes the main coronary reperfusion treatment with less risk of bleeding. Angiotensin-converting enzyme inhibitors were without effect on mortality.
背景/目的：描述 10 年急性心肌梗死（AMI）随访期间治疗实践的演变，并分析影响这些患者治疗选择和死亡率的因素。
Charleroi 缺血性心脏病登记册是比利时法语区最古老的梗塞登记册，也是少数能够识别 25 年以上趋势的登记册之一。此处呈现的分析仅涉及 1998 年至 2007 年期间各年龄段在 25-69 岁之间的患者。数据分 5 个 2 年时间段进行分析。使用卡方检验进行趋势分析，使用逻辑回归分析确定影响治疗类型的因素，以此分析随时间推移的治疗演变。
本研究表明，经皮腔内冠状动脉成形术（PTCA）的使用率在 1998-1999 年至 2006-2007 年期间显著增加。在 1998 年至 2007 年期间，约三分之一接受治疗的患者使用溶栓剂的情况相对稳定。有 AMI 病史的患者接受溶栓剂治疗的比例较低。溶栓似乎对男性有益，对女性无效。β-受体阻滞剂的使用持续增加，直到 2000-2001 年期间，随后两个时期相对稳定。42%的患者接受三种药物治疗（血管紧张素转换酶抑制剂、抗血小板药物和β-受体阻滞剂）。PTCA 与抗血小板药物、β-受体阻滞剂和溶栓的联合应用分别为 58.7%、50.6%和 25.7%。在调整性别、年龄和合并症后，仍观察到这些关联。与死亡率相关的因素是老年患者、糖尿病、高胆固醇血症和口服抗血小板药物、β-受体阻滞剂治疗和 PTCA 的病史。
该登记册中 AMI 治疗数据的演变证实了溶栓治疗的应用和疗效。PTCA 成为主要的冠状动脉再灌注治疗，出血风险较低。血管紧张素转换酶抑制剂对死亡率无影响。
