The University of Sydney, Faculty of Medicine, Sydney, NSW, Australia.
The University of Sydney, Concord Clinical School, Sydney, NSW, Australia.
Heart Lung Circ. 2019 Jul;28(7):1000-1008. doi: 10.1016/j.hlc.2018.05.191. Epub 2018 Jun 11.
Increased access to reperfusion for ST elevation myocardial infarction (STEMI) has contributed to reduced mortality internationally. We describe temporal trends in pre-hospital care, in-hospital management and outcomes of the STEMI population in Australia.
Temporal trends with multiple regression analysis on the management and outcomes of STEMI patients enrolled across 46 Australian hospitals in the Australian cohort of the Global Registry of Acute Coronary Events (GRACE) and the Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE) between February 1999 and August 2016.
4,110 patients were treated for STEMI, mean age 62.5±13.7years (SD). The median door-to-balloon time of primary percutaneous coronary intervention (PPCI) decreased by 11minutes (p<0.01) although there was no increase in rates of PPCI (p=0.35). Access to non-primary PCI increased by 39% (p<0.01), provisioning of fibrinolysis decreased by 13% (p<0.01) and the median door-to-needle time of 35minutes remained unchanged (p=0.09). Prescription of medical therapies in-hospital remained high, and at discharge there was an increase in prescription of statins (p<0.01); aspirin including antiplatelets (p<0.01), beta blockers (p=0.023) and ACE/ARB (p=0.02). The occurrence of any in-hospital adverse clinical events declined by 78% (p<0.01) albeit, there was no reduction in mortality in-hospital (p=0.84) or within 6 months (p=0.81).
Over time, there has been increased access to non-primary PCI; shorter door-to-balloon times for PPCI; less adverse events in-hospital and fewer readmissions for unplanned revascularisation without the realisation of reduced mortality in-hospital or at 6 months.
CONCORDANCE Registry ACTRN: 12614000887673.
ST 段抬高型心肌梗死（STEMI）再灌注治疗机会的增加，使国际上的死亡率降低。我们描述了澳大利亚 STEMI 人群的院前护理、院内管理和结局的时间趋势。
对 1999 年 2 月至 2016 年 8 月期间在澳大利亚队列的全球急性冠状动脉事件注册（GRACE）和合作国家急性冠状动脉护理指南依从性和临床事件（CONCORDANCE）登记册中登记的 46 家澳大利亚医院的 STEMI 患者的管理和结局进行多次回归分析。
共治疗了 4110 例 STEMI 患者，平均年龄为 62.5±13.7 岁（标准差）。直接经皮冠状动脉介入治疗（PPCI）的门球时间中位数减少了 11 分钟（p<0.01），但 PPCI 率没有增加（p=0.35）。非直接 PCI 的途径增加了 39%（p<0.01），纤溶治疗减少了 13%（p<0.01），而 35 分钟的门针时间中位数保持不变（p=0.09）。住院期间给予的医学治疗仍很高，出院时他汀类药物的处方增加（p<0.01）；阿司匹林包括抗血小板药物（p<0.01）、β受体阻滞剂（p=0.023）和 ACE/ARB（p=0.02）。住院期间任何不良临床事件的发生率下降了 78%（p<0.01），尽管住院期间或 6 个月内的死亡率没有下降（p=0.84）。
随着时间的推移，非直接 PCI 的途径增加了；PPCI 的门球时间更短；住院期间不良事件减少，计划外血运重建的再入院率降低，而住院期间或 6 个月内的死亡率没有降低。
CONCORDANCE 登记册 ACTRN：12614000887673。
