急性心肌梗死患者入住重症监护病房与死亡率的关联。

Association of intensive care unit admission and mortality in patients with acute myocardial infarction.

机构信息

Public Health Policy Division, Public Health Department, Public Health and Welfare Bureau, Kobe City, Kobe, Japan.

Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.

出版信息

J Cardiol. 2019 Aug;74(2):109-115. doi: 10.1016/j.jjcc.2019.01.007. Epub 2019 Feb 14.

DOI:10.1016/j.jjcc.2019.01.007

PMID:30773390

Abstract

BACKGROUND

An admission to the intensive care unit (ICU) after developing acute myocardial infarction (AMI) has been the standard of care and is recommended by professional societies. However, evidence that justifies its use, such as a reduction in mortality, has never been shown despite the associated financial burden. This study aimed to investigate the association between ICU admission and a reduction in 30-day mortality in patients who developed AMI.

METHODS

The multicenter retrospective cohort study was conducted using data from an administrative database between 2014 and 2016 in Japan. Patients with AMI as the primary diagnosis in the Diagnosis Procedure Combination database were included. Exposure was ICU admission, which was defined by an ICU management code in the claims record. Comparison was those without an ICU management code. The primary outcome was 30-day mortality. An association between ICU admission and a 30-day mortality was tested using a logistic regression model with random effects.

RESULTS

Of 18,745 patients [mean (standard deviation) age, 69 (13) years; 74% male] identified, 11,538 (62%) were admitted to ICUs and 7207 (38%) were admitted to non-ICUs. Among patients admitted to ICUs, 575 patients (5%) died within 30 days of admission, while 429 patients (6%) died in the non-ICU group. The association between ICU admission and mortality was confirmed both in unadjusted analysis [odds ratio (OR), 0.75; 95% confidence interval (CI), 0.64-0.89; p=0.001] and adjusted analysis (OR, 0.70; 95% CI, 0.54-0.90; p=0.01).

CONCLUSIONS

ICU admission was associated with lower 30-day mortality in patients who developed AMI.

摘要

背景

在发生急性心肌梗死（AMI）后入住重症监护病房（ICU）一直是护理标准，并得到专业协会的推荐。然而，尽管存在相关的经济负担，但从未有证据表明其使用是合理的，例如降低死亡率。本研究旨在调查 ICU 入院与降低发生 AMI 患者 30 天死亡率之间的关联。

方法

这项多中心回顾性队列研究使用了 2014 年至 2016 年期间日本行政数据库中的数据。将诊断程序组合数据库中主要诊断为 AMI 的患者纳入研究。暴露因素为 ICU 入院，这通过索赔记录中的 ICU 管理代码来定义。将其与没有 ICU 管理代码的患者进行比较。主要结局为 30 天死亡率。使用具有随机效应的 logistic 回归模型检验 ICU 入院与 30 天死亡率之间的关联。

结果

在确定的 18745 例患者中[平均（标准差）年龄 69（13）岁；74%为男性]，11538 例（62%）入住 ICU，7207 例（38%）入住非 ICU。入住 ICU 的患者中，575 例（5%）在入院后 30 天内死亡，而非 ICU 组中 429 例（6%）死亡。在未调整分析[比值比（OR），0.75；95%置信区间（CI），0.64-0.89；p=0.001]和调整分析（OR，0.70；95%CI，0.54-0.90；p=0.01）中均证实了 ICU 入院与死亡率之间的关联。