Lopes-Conceição Luísa, Pereira Marta, Araújo Carla, Laszczýnska Olga, Lunet Nuno, Azevedo Ana
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Centro Hospitalar de Trás-Os-Montes e Alto Douro EPE, Vila Real, Portugal.
Rev Port Cardiol. 2014 Nov;33(11):707-15. doi: 10.1016/j.repc.2013.11.013. Epub 2014 Nov 12.
Reperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal.
PubMed was searched in July 2012. The proportion of patients treated with fibrinolysis, primary percutaneous coronary intervention (PCI), any PCI and coronary artery bypass grafting (CABG) was described according to type of ACS: STEMI (≥90% patients with ST-segment elevation or Q-wave myocardial infarction), NSTE-ACS (≥90% patients with non-ST-segment elevation ACS) and mixed ACS (all others).
We identified 41 eligible studies, published between 1989 and 2011. Twenty-eight reported on samples considered representative of ACS patients treated in Portugal. The small number of estimates of the use of each treatment in STEMI and NSTE-ACS patients precluded identification of any time trend. In the last 20 years, the proportion of mixed ACS patients treated with fibrinolysis decreased and the use of PCI increased, while the use of CABG did not change.
The general pattern of the use of reperfusion and revascularization is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients. The relatively small number of estimates on the same procedure in comparable patients limits the generalizability of the conclusions, and highlights the need for systematic approaches to monitor the use of treatments over time.
再灌注和血运重建疗法在冠心病治疗中发挥着重要作用，并有助于降低病死率。我们旨在描述葡萄牙一段时间内这些疗法在急性冠脉综合征（ACS）患者治疗中的应用情况。
于2012年7月检索PubMed。根据ACS类型（ST段抬高型心肌梗死（STEMI，≥90%为ST段抬高或Q波心肌梗死患者）、非ST段抬高型ACS（NSTE-ACS，≥90%为非ST段抬高ACS患者）和混合型ACS（其他所有患者））描述接受纤溶治疗、直接经皮冠状动脉介入治疗（PCI）、任何PCI以及冠状动脉旁路移植术（CABG）的患者比例。
我们确定了41项符合条件的研究，发表于1989年至2011年之间。28项研究报告了被认为代表葡萄牙接受治疗的ACS患者的样本。由于STEMI和NSTE-ACS患者中每种治疗方法使用情况的估计数量较少，无法确定任何时间趋势。在过去20年中，接受纤溶治疗的混合型ACS患者比例下降，PCI的使用增加，而CABG的使用没有变化。
再灌注和血运重建的总体使用模式与其他发达国家报告的一致，反映出ACS患者护理质量的良好趋势。可比患者中相同程序的估计数量相对较少，限制了结论的普遍性，并突出了随着时间推移监测治疗使用情况的系统方法的必要性。
