Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Moo 16 Mitraphap Road, Muang District, Khon Kaen, 40002, Thailand.
Information and Outcome Evaluation Bureau, National Health Security Office, Bangkok, Thailand.
BMC Cardiovasc Disord. 2020 Mar 6;20(1):121. doi: 10.1186/s12872-020-01379-3.
Evidence on access to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI) and associated mortality in developing countries is scarce. This study determined time trends in the nationally aggregated reperfusion and mortality, examined distribution of percutaneous coronary intervention (PCI) utilization across provinces, and assessed the reperfusion-mortality association in Thailand that achieved universal health coverage in 2002.
Data on hospitalization with STEMI in 2011-2017 of 69,031 Universal Coverage Scheme (UCS) beneficiaries were used for estimating changes in the national aggregates of % reperfusion and mortality by a time-series analysis. Geographic distribution of PCI-capable hospitals and PCI recipients was illustrated per provinces. The reperfusion-mortality association was determined using the propensity-score matching of individual patients and panel data analysis at the hospital level. The exposure is a presence of PCI or thrombolysis. Outcomes are all-cause mortality within 30 and 180 days after an index hospitalization.
In 2011-2017, the PCI recipients increased annually 5.7 percentage (%) points and thrombolysis-only recipients decreased 2.2% points. The 30-day and 180-day mortalities respectively decreased annually 0.20 and 0.27% points among the PCI recipients, and they increased 0.79 and 0.59% points among the patients receiving no reperfusion over the same period. Outside Bangkok, the provinces with more than half of the patients receiving PCI increased from 4 provinces of PCI-capable hospitals in 2011 to 37 provinces, which included the neighboring provinces of the PCI-capable hospitals in 2017. Patients undergoing reperfusion had lower 30-day and 180-day mortalities respectively by 19.6 and 21.1% points for PCI, and by 14.1 and 15.1% points for thrombolysis only as compared with no reperfusion. The use of PCI was associated with decreases in 30-day and 180-day mortalities similarly by 5.4-5.5% points as compared with thrombolysis only. A hospital with 1% higher in the recipients of PCI had lower mortalities within 30 and 180 days by approximately 0.21 and 0.20%, respectively.
Patients with STEMI in Thailand experienced increasing PCI access and the use of PCI was associated with lower mortality compared with thrombolysis only. This is an evidence of progress toward a universal coverage of high-cost and effective health care.
在发展中国家，ST 段抬高型心肌梗死（STEMI）患者再灌注治疗的获得情况及其相关死亡率的证据很少。本研究旨在确定全国范围内再灌注和死亡率的时间趋势，检查经皮冠状动脉介入治疗（PCI）在各省的利用分布情况，并评估在 2002 年实现全民健康覆盖的泰国的再灌注-死亡率相关性。
利用 2011-2017 年全民覆盖计划（UCS）受益人的 STEMI 住院数据，通过时间序列分析估计国家再灌注和死亡率综合指标的变化。按省份说明有能力进行 PCI 的医院和接受 PCI 的患者的地理分布情况。使用个体患者的倾向评分匹配和医院层面的面板数据分析来确定再灌注-死亡率相关性。暴露因素是存在 PCI 或溶栓治疗。结果是指数住院后 30 天和 180 天的全因死亡率。
2011-2017 年，每年接受 PCI 的患者比例增加 5.7%，仅接受溶栓治疗的患者比例下降 2.2%。在接受 PCI 的患者中，30 天和 180 天的死亡率分别每年下降 0.20%和 0.27%，而在同期未接受再灌注治疗的患者中，死亡率分别上升 0.79%和 0.59%。在曼谷以外，有一半以上患者接受 PCI 的省份从 2011 年的 4 个有能力进行 PCI 的医院的省份增加到 2017 年的 37 个，其中包括有能力进行 PCI 的医院的邻近省份。与未进行再灌注治疗的患者相比，接受再灌注治疗的患者的 30 天和 180 天死亡率分别降低 19.6%和 21.1%，接受溶栓治疗的患者分别降低 14.1%和 15.1%。与仅接受溶栓治疗相比，使用 PCI 与 30 天和 180 天死亡率分别降低 5.4-5.5%相关。接受 PCI 的患者每增加 1%，30 天和 180 天的死亡率就会分别降低约 0.21%和 0.20%。
泰国 STEMI 患者接受 PCI 的机会增加，与仅接受溶栓治疗相比，使用 PCI 与死亡率降低相关。这是朝着全民享有高成本和有效的医疗保健服务这一目标迈进的证据。
