Al-Jarallah Mohammad, Al-Mallah Mouaz H, Zubaid Mohammad, Alsheikh-Ali Alawi A, Rashed Wafa, Ridha Mustafa, Alenizi Fahad, Bulbanat Bassam, Akbar Mousa, Al-Hamdan Rashed, Zubair Shahid
Division of Cardiology, Al-Amiri Hospital, Kuwait.
Open Cardiovasc Med J. 2011;5:171-8. doi: 10.2174/1874192401105010171. Epub 2011 Aug 1.
To evaluate changes in management practices and its influence on short term hospital outcomes in patients with acute myocardial infarction (AMI) admitted during two different time periods, 2007 and 2004.
We studied AMI patients from two acute coronary syndrome registries carried out in Kuwait in 2007 and 2004. We included 1872 and 1197 patients from the 2007 and 2004 registries, respectively. When compared with 2004, patients from the 2007 registry had similar baseline clinical characteristics. In 2007 compared to 2004, during the in-hospital period, patients with AMI received significantly more statins (94% vs. 73%%, p<0.0001), Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) (70% vs. 47%, p<0.001), and Clopidogrel (38% vs. 4%, p<0.001), while beta-blockers use dropped in 2007 compared to 2004 (63% vs. 68%, p=0.0066). The rates of in-hospital mortality and recurrent ischemia were significantly lower in the 2007 cohort compared with the 2004 cohort (for mortality 2.2% vs. 3.9%, P=0.0008, for recurrent ischemia 13.7% vs. 20.4%, P=0<0.0001).Higher utilization of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and statins were the main contributors to the improved in-hospital mortality and morbidity.
In the acute management of AMI, there was a significant increase in the use of statins, ACE inhibitors and Clopidogrel in 2007 compared to 2004. This was associated with a significant decrease in the in-hospital mortality and recurrent ischemia. Adherence to guidelines recommended therapies improved in-hospital outcomes.
评估2007年和2004年这两个不同时间段收治的急性心肌梗死（AMI）患者管理措施的变化及其对短期住院结局的影响。
我们研究了2007年和2004年在科威特进行的两个急性冠状动脉综合征登记处的AMI患者。我们分别纳入了2007年登记处的1872例患者和2004年登记处的1197例患者。与2004年相比，2007年登记处的患者具有相似的基线临床特征。与2004年相比，2007年住院期间，AMI患者接受他汀类药物治疗的比例显著更高（94%对73%，p<0.0001），血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）（70%对47%，p<0.001），以及氯吡格雷（38%对4%，p<0.001），而2007年与2004年相比β受体阻滞剂的使用有所下降（63%对68%，p=0.0066）。2007年队列的住院死亡率和再发缺血发生率显著低于2004年队列（死亡率2.2%对3.9%，P=0.0008；再发缺血发生率13.7%对20.4%，P<0.0001）。血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和他汀类药物的更高使用率是住院死亡率和发病率改善的主要原因。
在AMI的急性管理中，与2004年相比，2007年他汀类药物、ACE抑制剂和氯吡格雷的使用显著增加。这与住院死亡率和再发缺血的显著降低相关。遵循指南推荐的治疗方法可改善住院结局。
