Akimbaeva Zhanar, Ismailov Zhumagali, Akanov Aikan A, Radišauskas Ričardas, Padaiga Žilvinas
Kazakh National Medical University, Almaty, Kazakhstan.
Kazakh Republican Center for Health Development, Astana, Kazakhstan.
Medicina (Kaunas). 2017;53(1):58-65. doi: 10.1016/j.medici.2017.01.006. Epub 2017 Feb 20.
The aim of this study was to assess and evaluate factors related to coronary care management and hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized in the Kazakhstan County and city hospitals in which percutaneous coronary intervention (PCI) was performed during the period of 2012-2015.
A total of 22,176 adult patients (18> years) with acute STEMI were hospitalized from January 2012 to December 2015. All the investigated STEMI patients underwent PCI.
The mean age of STEMI patients was 61.52±11.48 years, 72.2% of the patients were male and 75.2% living in the rural regions. The mean time from hospitalization to PCI was 2104.41±5060.68min (median 95.0 and IQR 1034.5). The mean and median of time from hospitalization to PCI tended to decrease from 2747.7±5793.9min and 155.0min in 2012 to 1874.7±4759.2min and 73.5min in 2015. Among all STEMI events the percentage of patients from hospitalization to PCI within 0-59min was up to 39.0% during all study period. From 2012 to 2015, the percentage of STEMI patients with short time (0-59min) of hospitalization to PCI tended to increase in average by 11.4% per year (P=0.09). Among all STEMI patients hospital mortality from 2012 to 2015 did not change significantly and ranged from 9.0% in 2012 to 8.6% in 2015. By multiple logistic regression analysis, study years (2012), gender (female), age (60> years), time from hospitalization to PCI (60>min) and number of bed-days were statistically significant factors associated with patients' hospital mortality from STEMI with PCI.
The present study demonstrated that hospitalization delay in the treatment of STEMI patients in Kazakhstan population was without significant changes, meanwhile the number of patients perfused within 1h from hospitalization to PCI tended to increase during 2012-2015. The higher hospital mortality was associated with study year, female gender, older age, longer-time from hospitalization to PCI and shorter hospitalization.
本研究旨在评估和评价2012 - 2015年期间在哈萨克斯坦州县医院住院并接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的冠状动脉护理管理相关因素及医院死亡率。
2012年1月至2015年12月，共有22176例成年急性STEMI患者（年龄>18岁）住院。所有纳入研究的STEMI患者均接受了PCI治疗。
STEMI患者的平均年龄为61.52±11.48岁，72.2%为男性，75.2%居住在农村地区。从住院到PCI的平均时间为2104.41±5060.68分钟（中位数95.0，四分位间距1034.5）。从住院到PCI的平均时间和中位数呈下降趋势，从2012年的2747.7±5793.9分钟和155.0分钟降至2015年的1874.7±4759.2分钟和73.5分钟。在所有STEMI病例中，从住院到PCI在0 - 59分钟内的患者比例在整个研究期间高达39.0%。2012年至2015年，STEMI患者从住院到PCI时间短（0 - 59分钟）的比例平均每年上升11.4%（P = 0.09）。2012年至2015年，所有STEMI患者的医院死亡率无显著变化，范围从2012年的9.0%至2015年的8.6%。通过多因素logistic回归分析，研究年份（2012年）、性别（女性）、年龄（>60岁）、从住院到PCI的时间（>60分钟）和住院天数是与接受PCI的STEMI患者医院死亡率相关的统计学显著因素。
本研究表明，哈萨克斯坦人群中STEMI患者的住院延迟治疗情况无显著变化，同时在2012 - 2015年期间，从住院到PCI在1小时内接受灌注治疗的患者数量呈上升趋势。较高医院死亡率与研究年份、女性性别、年龄较大、从住院到PCI时间较长以及住院时间较短有关。
