Cordero Alberto, López-Palop Ramón, Carrillo Pilar, Frutos Araceli, Miralles Sandra, Gunturiz Clara, García-Carrilero María, Bertomeu-Martínez Vicente
Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
Rev Esp Cardiol (Engl Ed). 2016 Aug;69(8):754-9. doi: 10.1016/j.rec.2015.12.021. Epub 2016 Mar 12.
Emergency care systems have been created to improve treatment and revascularization in myocardial infarction but they may also improve the management of all patients with acute coronary syndrome.
A comparative study of all patients admitted with acute coronary syndrome before and after implementation of an infarction protocol.
The study included 1210 patients. While the mean age was the same in both periods, the patient group admitted after implementation of the protocol had a lower prevalence of diabetes mellitus and hypertension but more active smokers and higher GRACE scores. The percentage of ST-segment elevation acute coronary syndrome (29.8%-39.5%) and coronary revascularizations (82.1%-90.1%) significantly increased among patients admitted with acute coronary syndrome, and primary angioplasty became routine (51.9%-94.9%); there was also a reduction in time to catheterization and an increase in early revascularization. The mean hospital stay was significantly shorter after implementation of the infarction protocol. In-hospital mortality was unchanged, except in high-risk patients (38.8%-22.4%). After discharge, no differences were observed between the 2 periods in cardiovascular mortality, all-cause mortality, reinfarction, or major cardiovascular complications.
After implementation of the infarction protocol, the percentage of patients admitted with ST-segment elevation acute coronary syndrome and the mean GRACE score increased among patients admitted with acute coronary syndrome. Hospital stay was reduced, and primary angioplasty use increased. In-hospital mortality was reduced in high-risk patients, and prognosis after discharge was the same in both periods.
建立急诊医疗系统是为了改善心肌梗死的治疗和血管再通，但它们也可能改善所有急性冠状动脉综合征患者的管理。
对实施心肌梗死治疗方案前后所有因急性冠状动脉综合征入院的患者进行一项对比研究。
该研究纳入了1210名患者。虽然两个时期的平均年龄相同，但实施治疗方案后入院的患者组糖尿病和高血压患病率较低，但吸烟者更活跃，GRACE评分更高。急性冠状动脉综合征患者中ST段抬高型急性冠状动脉综合征的比例（29.8%-39.5%）和冠状动脉血管再通的比例（82.1%-90.1%）显著增加，直接经皮冠状动脉腔内血管成形术成为常规治疗（51.9%-94.9%）；导管插入时间也有所缩短，早期血管再通增加。实施心肌梗死治疗方案后平均住院时间显著缩短。除高危患者外（38.8%-22.4%），住院死亡率无变化。出院后，两个时期在心血管死亡率、全因死亡率、再梗死或主要心血管并发症方面未观察到差异。
实施心肌梗死治疗方案后，急性冠状动脉综合征患者中ST段抬高型急性冠状动脉综合征患者的比例和平均GRACE评分增加。住院时间缩短，直接经皮冠状动脉腔内血管成形术的使用增加。高危患者的住院死亡率降低，两个时期出院后的预后相同。
