Blöndal Mai, Ainla Tiia, Marandi Toomas, Baburin Aleksei, Eha Jaan
Department of Cardiology, University of Tartu, L, Puusepa 8, 51014 Tartu, Estonia.
BMC Res Notes. 2012 Jan 26;5:71. doi: 10.1186/1756-0500-5-71.
High quality care for acute myocardial infarction (AMI) improves patient outcomes. Still, AMI patients are treated in hospitals with unequal access to percutaneous coronary intervention. The study compares changes in treatment and 30-day and 3-year mortality of AMI patients hospitalized into tertiary and secondary care hospitals in Estonia in 2001 and 2007.
Final analysis included 423 cases in 2001 (210 from tertiary and 213 from secondary care hospitals) and 687 cases in 2007 (327 from tertiary and 360 from secondary care hospitals). The study sample in 2007 was older and had twice more often diabetes mellitus. The patients in the tertiary care hospitals underwent reperfusion for ST-elevation myocardial infarction, cardiac catheterization and revascularisation up to twice as often in 2007 as in 2001. In the secondary care, patient transfer for further invasive treatment into tertiary care hospitals increased (P < 0.001). Prescription rates of evidence-based medications for in-hospital and for outpatient use were higher in 2007 in both types of hospitals. However, better treatment did not improve significantly the short- and long-term mortality within a hospital type in crude and baseline-adjusted analysis. Still, in 2007 a mortality gap between the two hospital types was observed (P < 0.010).
AMI treatment improved in both types of hospitals, while the improvement was more pronounced in tertiary care. Still, better treatment did not result in a significantly lower mortality. Higher age and cardiovascular risk are posing a challenge for AMI treatment.
急性心肌梗死（AMI）的高质量治疗可改善患者预后。然而，AMI患者在接受经皮冠状动脉介入治疗机会不均等的医院接受治疗。本研究比较了2001年和2007年爱沙尼亚三级和二级医疗机构中住院的AMI患者的治疗变化以及30天和3年死亡率。
最终分析纳入了2001年的423例病例（210例来自三级医疗机构，213例来自二级医疗机构）和2007年的687例病例（327例来自三级医疗机构，360例来自二级医疗机构）。2007年的研究样本年龄更大，糖尿病患者的比例是原来的两倍。2007年，三级医疗机构中因ST段抬高型心肌梗死接受再灌注治疗、心脏导管插入术和血运重建术的患者频率高达2001年的两倍。在二级医疗机构中，转往三级医疗机构接受进一步侵入性治疗的患者有所增加（P < 0.001）。2007年，两类医院中住院和门诊使用循证药物的处方率均更高。然而，在粗略分析和基线调整分析中，更好的治疗并未显著改善同一医院类型内患者的短期和长期死亡率。不过，2007年观察到两类医院之间存在死亡率差距（P < 0.010）。
两类医院的AMI治疗均有改善，而三级医疗机构的改善更为明显。然而，更好的治疗并未显著降低死亡率。更高的年龄和心血管风险对AMI治疗构成挑战。
