Balzi Daniela, Di Bari Mauro, Barchielli Alessandro, Ballo Piercarlo, Carrabba Nazario, Cordisco Antonella, Landini Maria Cristina, Santoro Giovanni Maria, Valente Serafina, Zuppiroli Alfredo, Marchionni Niccolò, Gensini Gian Franco
Epidemiology Unit, Local Health Unit 10 Firenze, Via di San Salvi 12, 50135, Florence, Italy,
Intern Emerg Med. 2013 Dec;8(8):725-33. doi: 10.1007/s11739-012-0817-6. Epub 2012 Jul 10.
ST-segment and non-ST-segment elevation myocardial infarction (STEMI, NSTEMI) have opposite epidemiology, the latter being nowadays more common than the former. Consistently with these epidemiological trends, application of evidence-based clinical practice guidelines on the management of NSTEMI should be promoted. We compared clinical features, hospital management and prognosis of STEMI/NSTEMI in an unselected cohort of 1,496 prospectively enrolled patients (STEMI, 36.9 % and NSTEMI, 63.1 %), admitted in 1 year to one of the six hospitals in Florence health district (Italy). Vital status was assessed after 1 year. NSTEMI patients were older, more often female, and affected by cardiovascular and non-cardiovascular comorbidities. Percutaneous coronary intervention (PCI) was performed more often in STEMI (82 %) than in NSTEMI patients (48 %, p < 0.001). Aspirin, clopidogrel, statins, beta-blockers, and ACE-inhibitors were prescribed more frequently in STEMI. In-hospital mortality was significantly lower in NSTEMI than in STEMI (4.2 vs. 8.9 %, p < 0.001), even after adjusting for confounders in a multivariable logistic model (OR 0.27, 95 % CI 0.16-0.45). One-year mortality was similar in NSTEMI and STEMI patients in an unadjusted comparison (18.0 vs. 16.7 %, p = 0.51), but it was lower in NSTEMI patients in multivariable Cox analysis (HR 0.56, 95 % CI 0.42-0.75). PCI reduced the risk of 1-year mortality similarly in STEMI (HR 0.47, 95 % CI 0.28-0.79) and NSTEMI (HR 0.41, 95 % CI 0.28-0.60). PCI reduces mortality in both STEMI and NSTEMI, but it is underutilised in patients with NSTEMI. To improve overall prognosis of AMI, efforts should be made at improving the care of NSTEMI patients.
ST段抬高型心肌梗死和非ST段抬高型心肌梗死（STEMI、NSTEMI）有着相反的流行病学特征，如今后者比前者更为常见。与这些流行病学趋势一致，应推广基于证据的NSTEMI管理临床实践指南。我们比较了意大利佛罗伦萨卫生区六家医院之一在1年内前瞻性纳入的1496例患者（STEMI占36.9%，NSTEMI占63.1%）这一未选择队列中STEMI/NSTEMI的临床特征、医院管理及预后。1年后评估生存状态。NSTEMI患者年龄更大，女性更多见，且合并心血管及非心血管疾病。STEMI患者接受经皮冠状动脉介入治疗（PCI）的比例（82%）高于NSTEMI患者（48%，p<0.001）。STEMI患者阿司匹林、氯吡格雷、他汀类药物、β受体阻滞剂及血管紧张素转换酶抑制剂的处方频率更高。即使在多变量逻辑模型中对混杂因素进行校正后，NSTEMI患者的院内死亡率仍显著低于STEMI患者（4.2%对8.9%，p<0.001）（比值比0.27，95%置信区间0.16 - 0.45）。在未经调整的比较中，NSTEMI和STEMI患者的1年死亡率相似（18.0%对16.7%，p = 0.51），但在多变量Cox分析中NSTEMI患者的1年死亡率更低（风险比0.56，95%置信区间0.42 - 0.75）。PCI在STEMI（风险比0.47，95%置信区间0.28 - 0.79）和NSTEMI（风险比0.41，95%置信区间0.28 - 0.60）中降低1年死亡率的风险相似。PCI可降低STEMI和NSTEMI患者的死亡率，但在NSTEMI患者中未得到充分利用。为改善急性心肌梗死的总体预后，应努力改善对NSTEMI患者的治疗。
