Shevchenko I I, Érlikh A D, Islamov R R, Budiak V A, Provotorov V M, Gratsianskiĭ N A
Voronezh City Clinical Hospital of Emergency Care 10, ul. Minskaya 43, 394033 Voronezh, Russia.
Kardiologiia. 2013;53(8):4-10.
Positive changes are declared to occur during recent years in management of hospitalized patients with acute coronary syndromes (ACS) in Russia. Most of these changes are related to availability of invasive treatment. But considerable portion of patients (pts) are still treated in hospitals without facilities for invasive myocardial revascularization (noninvasive hospitals - NIHs). Aim of this study was to compare some characteristics of management of ACS in NIHs which participated in ACS registries RECORD (2007-2008, 8 NIHs from 6 cities; n=381) and RECORD-2 (2009-2011, 3 NIHs from 3 cities, n=680). Results. Groups of pts recruited in these NIHs had similar mean age and portion of women (67.6 and 66.5 years, 51.1 and 53.1 % in RECORD-2 and RECORD, respectively, p=0.64). Time from symptoms onset to hospitalization was shorter in RECORD-2 (3.2 vs 4.1 hours for ST-elevation [STE], =0.03; 4.0 vs 6.5 hours for non ST elevation [NSTE] ACS, <0.0001). Among RECORD-2 NSTEACS pts more had ST depressions (50.6 vs 28.7%, <0.0001), high risk of death according to GRACE score (39.1 vs 20.9 %, <0.0001), but less Killip class >II (15.0 vs 21.6%, p=0.025). No such differences existed among STEACS pts. Thrombolysis was more often used in RECORD-2 (62.6 vs 34.1%, <0.0001). Both STEACS and NSTEACS RECORD-2 pts more often received clopidogrel (63.5 vs 18.8%, p<0.0001, and 41.6 vs 11.1%, <0.0001, respectively). More NSTEACS RECORD-2 pts were given parenteral anticoagulants (93.4 vs 80.4%, <0.0001), low molecular weight heparins (23.4 vs. 3.4%, <0.0001) and fondaparinux (10.4 vs 0.7%, <0.0001), but still in 20% of NSTEACS RECORD-2 pts unfractionated heparin was given subcutaneously. Twenty RECORD-2 pts (2.9%) were transferred to invasive hospital but none during first 24 hours. There were no significant differences between registers in hospital mortality (20.0 vs 21.2%, =0.84; 4.2 vs 2.7%, =0.24 in STE and NSTE ACS pts of RECORD-2 and RECORD, respectively). Conclusions. Despite some improvement in management of pts occurring in 2-3 years NIHs mortality in STEACS remained very high. Numerically higher mortality in NSTEACS could be partially attributed to higher risk of RECORD-2 pts.
据宣称，近年来俄罗斯急性冠状动脉综合征（ACS）住院患者的管理出现了积极变化。这些变化大多与侵入性治疗的可及性有关。但仍有相当一部分患者在没有侵入性心肌血运重建设施的医院（非侵入性医院 - NIHs）接受治疗。本研究的目的是比较参与ACS注册研究RECORD（2007 - 2008年，来自6个城市的8家NIHs；n = 381）和RECORD - 2（2009 - 2011年，来自3个城市的3家NIHs，n = 680）的NIHs中ACS管理的一些特征。结果。这些NIHs招募的患者组平均年龄和女性比例相似（RECORD - 2和RECORD中分别为67.6岁和66.5岁，51.1%和53.1%，p = 0.64）。RECORD - 2中从症状发作到住院的时间更短（ST段抬高[STE]为3.2小时对4.1小时，p = 0.03；非ST段抬高[NSTE]ACS为4.0小时对6.5小时，p < 0.0001）。在RECORD - 2的NSTEACS患者中，更多患者有ST段压低（50.6%对28.7%，p < 0.0001），根据GRACE评分死亡风险高（39.1%对20.9%，p < 0.0001），但Killip分级>II的患者较少（15.0%对21.6%，p = 0.025）。STEACS患者之间不存在此类差异。RECORD - 2中更常使用溶栓治疗（62.6%对34.1%，p < 0.0001）。RECORD - 2的STEACS和NSTEACS患者更常接受氯吡格雷治疗（分别为63.5%对18.8%，p < 0.0001，以及41.6%对11.1%，p < 0.0001）。RECORD - 2的更多NSTEACS患者接受了胃肠外抗凝剂治疗（93.4%对80.4%，p < 0.0001）、低分子量肝素治疗（23.4%对3.4%，p < 0.0001）和磺达肝癸钠治疗（10.4%对0.7%，p < 0.00
