澳大利亚和新西兰的急性冠状动脉综合征治疗情况：SNAPSHOT ACS 研究。

Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study.

机构信息

Department of Cardiovascular Medicine, Flinders University, Adelaide, SA.

出版信息

Med J Aust. 2013 Aug 5;199(3):185-91. doi: 10.5694/mja12.11854.

DOI:10.5694/mja12.11854

PMID:23909541

Abstract

OBJECTIVES

To characterise management of suspected acute coronary syndrome (ACS) in Australia and New Zealand, and to assess the application of recommended therapies according to published guidelines.

DESIGN, SETTING AND PATIENTS: All patients hospitalised with suspected or confirmed ACS between 14 and 27 May 2012 were enrolled from participating sites in Australia and New Zealand, which were identified through public records and health networks. Descriptive and logistic regression analysis was performed.

MAIN OUTCOME MEASURES

Rates of guideline-recommended investigations and therapies, and inhospital clinical events (death, new or recurrent myocardial infarction [MI], stroke, cardiac arrest and worsening congestive heart failure).

RESULTS

Of 478 sites that gained ethics approval to participate, 286 sites provided data on 4398 patients with suspected or confirmed ACS. Patients' mean age was 67 2013s (SD, 15 2013s), 40% were women, and the median Global Registry of Acute Coronary Events (GRACE) risk score was 119 (interquartile range, 96-144). Most patients (66%) presented to principal referral hospitals. MI was diagnosed in 1436 patients (33%), unstable angina or likely ischaemic chest pain in 929 (21%), unlikely ischaemic chest pain in 1196 (27%), and 837 patients (19%) had other diagnoses not due to ACS. Of the patients with MI, 1019 (71%) were treated with angiography, 610 (43%) with percutaneous coronary intervention and 116 (8%) with coronary artery bypass grafting. Invasive management was less likely with increasing patient risk (GRACE score < 100, 90.1% v 101-150, 81.3% v 151-200, 49.4% v > 200, 36.1%; P < 0.001). The inhospital mortality rate was 4.5% and recurrent MI rate was 5.1%. After adjusting for patient risk and other variables, significant variations in care and outcomes by hospital classification and jurisdiction were evident.

CONCLUSION

This first comprehensive combined Australia and New Zealand audit of ACS care identified variations in the application of the ACS evidence base and varying rates of inhospital clinical events. A focus on integrated clinical service delivery may provide greater translation of evidence to practice and improve ACS outcomes in Australia and New Zealand.

摘要

目的

描述澳大利亚和新西兰疑似急性冠状动脉综合征（ACS）的管理情况，并评估根据已发表指南应用推荐治疗方法的情况。

设计、地点和患者：2012 年 5 月 14 日至 27 日期间，从澳大利亚和新西兰参与研究的医疗机构中，选取所有疑似或确诊 ACS 住院患者。通过公开记录和卫生网络识别这些医疗机构。采用描述性和逻辑回归分析。

主要结局指标

指南推荐的检查和治疗方法的应用率，以及住院期间的临床结局（死亡、新发或复发性心肌梗死[MI]、卒中、心脏骤停和充血性心力衰竭恶化）。

结果

在获得参与伦理批准的 478 个机构中，有 286 个机构提供了 4398 例疑似或确诊 ACS 患者的数据。患者平均年龄 67 岁（标准差 15 岁），40%为女性，全球急性冠状动脉事件注册（GRACE）风险评分中位数为 119（四分位距 96-144）。大多数患者（66%）就诊于主要转诊医院。1436 例（33%）诊断为 MI，929 例（21%）诊断为不稳定型心绞痛或可能为缺血性胸痛，1196 例（27%）诊断为不太可能为缺血性胸痛，837 例（19%）诊断为其他非 ACS 相关疾病。在 MI 患者中，1019 例（71%）接受了血管造影检查，610 例（43%）接受了经皮冠状动脉介入治疗，116 例（8%）接受了冠状动脉旁路移植术。随着患者风险的增加（GRACE 评分<100 者为 90.1%，101-150 者为 81.3%，151-200 者为 49.4%，>200 者为 36.1%，P<0.001），进行有创性管理的可能性降低。住院期间死亡率为 4.5%，再发 MI 率为 5.1%。在调整了患者风险和其他变量后，医院分类和司法管辖区之间在治疗和结局方面的显著差异仍然存在。