3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Kardiol Pol. 2011;69(11):1109-18.
A substantial progress has been made in Poland in the field of acute coronary syndromes (ACS) management over the last 10 years.
To present the data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) collected between 2003 and 2009. Changes in treatment strategies and outcomes in ST-segment myocardial infarction (STEMI) were analysed.
We analysed patients enrolled to the PL-ACS Registry - a nationwide multicenter, prospective observational study of consecutive patients hospitalised with ACS in Poland.
Overall, 284,162 patients with ACS were enrolled in 512 centres including 88 invasive cardiology centres. The STEMI was diagnosed in 35-36% of these patients in 2003-2005, and this proportion remained stable at 30% to 32% in 2006-2009. The mean age of STEMI patients increased from 62.5 years in 2003 to 64.5 in 2009. During this period, women represented 32.7% to 34.6% of the STEMI patients. Proportion of patients presenting with pulmonary oedema or cardiogenic shock decreased with time, from 15.5% in 2003 to 8% in 2009. Delays to reperfusion tended to reduce over time: pain-to- -admission time was 240 min in 2005 and 229 min in 2009 and door-to-balloon time was 32 and 25 min in 2005 and 2009, respectively, with the delay being longer in the elderly population. The proportion of patients undergoing coronary angiography showed a constant increase, from 55% in 2003 to 84% in 2009. Percutaneous coronary intervention was performed in 51% and 78% of patients in 2003 and 2009, respectively. At the same time, the proportion of patients undergoing thrombolysis declined from 14% to 1%. Aspirin, beta-blocker, statin and ACE inhibitor use was constantly high, while nitrate use declined from 82% to 15%. The proportion of patients receiving clopidogrel increased from 40% to 97% over the analysed period. Significant reductions in mortality rates were observed: in-hospital mortality decreased from 11.9% to 6.4%; 30-day mortality from 13.5% to 9.6%; and 12-month mortality from 19.8% to 15.4% in 2003 and 2009, respectively. Invasive treatment strategy was associated with better in-hospital and long-term patient survival.
The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock.
在过去的 10 年中，波兰在急性冠状动脉综合征（ACS）管理领域取得了重大进展。
介绍 2003 年至 2009 年期间收集的波兰急性冠状动脉综合征注册（PL-ACS）的数据。分析 ST 段抬高型心肌梗死（STEMI）治疗策略和结果的变化。
我们分析了纳入 PL-ACS 注册的患者-这是一项全国多中心、前瞻性观察性研究，纳入了波兰因 ACS 住院的连续患者。
共有 284162 例 ACS 患者被纳入 512 个中心，其中包括 88 个介入心脏病学中心。这些患者中 35-36%在 2003-2005 年被诊断为 STEMI，在 2006-2009 年这一比例保持在 30%-32%的稳定水平。STEMI 患者的平均年龄从 2003 年的 62.5 岁增加到 2009 年的 64.5 岁。在此期间，女性占 STEMI 患者的 32.7%-34.6%。随着时间的推移，出现肺水肿或心源性休克的患者比例下降，从 2003 年的 15.5%下降到 2009 年的 8%。再灌注时间趋于减少：胸痛至入院时间从 2005 年的 240 分钟减少到 2009 年的 229 分钟，门球时间分别为 2005 年和 2009 年的 32 分钟和 25 分钟，老年患者的延迟时间更长。接受冠状动脉造影的患者比例呈持续上升趋势，从 2003 年的 55%上升到 2009 年的 84%。2003 年和 2009 年分别有 51%和 78%的患者接受经皮冠状动脉介入治疗。同时，接受溶栓治疗的患者比例从 14%下降到 1%。阿司匹林、β受体阻滞剂、他汀类药物和 ACE 抑制剂的使用率一直很高，而硝酸盐的使用率从 82%下降到 15%。氯吡格雷的使用率从 2003 年的 40%增加到 97%。观察到死亡率显著下降：院内死亡率从 11.9%降至 6.4%；30 天死亡率从 13.5%降至 9.6%；12 个月死亡率从 19.8%降至 15.4%，分别为 2003 年和 2009 年。侵入性治疗策略与住院和长期患者生存的改善相关。
PL-ACS 登记处的结果表明，STEMI 患者的短期和长期死亡率较低，主要是由于经常使用介入治疗策略、良好的物流和适当的药物治疗。因此，住院时间缩短。然而，仍有几个问题需要改进，例如缩短院前延迟时间，并提高心源性休克患者的侵入性治疗率。
