Socias L, Frontera G, Rubert C, Carrillo A, Peral V, Rodriguez A, Royo C, Ferreruela M, Torres J, Elosua R, Bethencourt A, Fiol M
Servicio de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, España.
Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitario Son Espases, Palma de Mallorca, España.
Med Intensiva. 2016 Dec;40(9):541-549. doi: 10.1016/j.medin.2016.04.001. Epub 2016 Jun 11.
To investigate the differences in mortality at 28 days and other prognostic variables in 2 periods: IBERICA-Mallorca (1996-1998) and Infarction Code of the Balearic Islands (IC-IB) (2008-2010).
Two observational prospective cohorts.
Hospital Universitario Son Dureta, 1996-1998 and 2008-2010.
Acute coronary syndrome with ST elevation of≤24h of anterior and inferior site.
Age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty, administration of acetylsalicylic acid, beta blockers and angiotensin converting enzyme inhibitors. Killip class, malignant arrhythmias, mechanical complications and death at 28 days were included.
Four hundred and forty-two of the 889 patients included in the IBERICA-Mallorca and 498 of 847 in the IC-IB were analyzed. The site and Killip class on admission were similar in both cohorts. The main significant difference between IBERICA and IC-IB group were age (64 vs. 58 years), prior myocardial infarction (17.9 vs. 8.1%), the median symtoms to first ECG time (120 vs. 90min), median first ECG to fibrinolysis time (60 vs. 35min), fibrinolytic therapy (54.8 vs. 18.7%), patients without revascularization treatment (45.9 vs. 9.2%), primary angioplasty (1.0% vs. 92.0%). The mortality at 28 days was lower in the IC-IB (12.2 vs. 7.2%; hazard ratio 0.560; 95% CI 0.360-0.872; P=.010).
The 28-day mortality in acute coronary syndrome with ST elevation in Mallorca has declined in the last decade, basically due to increased reperfusion therapy with primary angioplasty and reducing delays time to reperfusion.
调查两个时期（伊比利亚-马略卡研究[1996 - 1998年]和巴利阿里群岛心肌梗死编码研究[IC - IB][2008 - 2010年]）28天死亡率及其他预后变量的差异。
两项前瞻性观察队列研究。
1996 - 1998年及2008 - 2010年的Son Dureta大学医院。
前壁和下壁ST段抬高≤24小时的急性冠状动脉综合征患者。
年龄、性别、心血管危险因素、急性心肌梗死部位、时间延迟、纤溶和直接冠状动脉介入的再灌注治疗、阿司匹林、β受体阻滞剂及血管紧张素转换酶抑制剂的使用情况。纳入Killip分级、恶性心律失常、机械并发症及28天死亡率。
伊比利亚-马略卡研究纳入的889例患者中有442例、IC - IB研究纳入的847例患者中有498例接受了分析。两个队列入院时的梗死部位和Killip分级相似。伊比利亚研究组和IC - IB研究组之间的主要显著差异在于年龄（64岁对58岁）、既往心肌梗死（17.9%对8.1%）、首次症状发作至首次心电图的中位时间（120分钟对90分钟）、首次心电图至纤溶的中位时间（60分钟对35分钟）、纤溶治疗（54.8%对18.7%）、未接受血运重建治疗的患者（45.9%对9.2%）、直接冠状动脉介入治疗（1.0%对92.0%）。IC - IB研究组28天死亡率较低（12.2%对7.2%；风险比0.560；95%可信区间0.360 - 0.872；P = 0.010）。
过去十年中，马略卡岛ST段抬高型急性冠状动脉综合征患者的28天死亡率有所下降，主要原因是直接冠状动脉介入再灌注治疗增加以及再灌注延迟时间缩短。
