2001 年至 2015 年中国急性心肌梗死患者静脉使用硫酸镁的情况：中国胸痛注册研究-回顾性 AMI 研究。

Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE-Retrospective AMI Study.

机构信息

National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.

出版信息

BMJ Open. 2020 Mar 26;10(3):e033269. doi: 10.1136/bmjopen-2019-033269.

DOI:10.1136/bmjopen-2019-033269

PMID:32220910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7170603/

Abstract

OBJECTIVE

In 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in the use of intravenous magnesium sulfate in nationally representative samples of individuals hospitalised with AMI in China between 2001 and 2015.

METHODS

In an observational study (China PEACE-Retrospective Study) of AMI care, we used a two-stage, random sampling strategy to create a nationally representative sample of 28 208 patients with AMI at 162 Chinese hospitals in 2001, 2006, 2011 and 2015. The main outcome is use of intravenous magnesium sulfate over time.

RESULTS

We identified 24 418 patients admitted for AMI, without hypokalaemia, in the four study years. Over time, there was a significant initial decrease in intravenous magnesium sulfate use, from 32.1% in 2001 to 17.1% in 2015 (p<0.001 for trend). The decline was greater in the Eastern (from 33.3% to 16.5%) and Western (from 34.8% to 17.2%) regions, as compared with the Central region (from 25.9% to 18.1%), with little difference between rural and urban areas. The proportion of hospitals using intravenous magnesium sulfate did not change over time (from 81.3% to 77.9%). The median ORs, representing hospital-level variation, were 6.03 in 2001, 3.86 in 2006, 4.26 in 2011 and 4.72 in 2015. Intravenous magnesium sulfate use was associated with cardiac arrest at admission and receipt of reperfusion therapy, but no hospital-specific characteristics.

CONCLUSIONS

Despite recommendations against its use, intravenous magnesium sulfate is used in about one in six patients with AMI in China. Our findings highlight the need for more efficient mechanisms to stop using ineffective therapies to improve patients' outcomes and reduce medical waste.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT01624883).

摘要

目的

2001 年，中国急性心肌梗死（AMI）治疗指南提出新的建议，反对常规使用硫酸镁。我们研究了 2001 年至 2015 年中国 AMI 住院患者的全国代表性样本中，静脉内硫酸镁的使用情况随时间的变化趋势和机构间的差异。

方法

在 AMI 治疗的观察性研究（中国 PEACE 回顾性研究）中，我们采用两阶段随机抽样策略，在 2001 年、2006 年、2011 年和 2015 年的 162 家中国医院中创建了一个具有全国代表性的 28208 例 AMI 患者的样本。主要结局是静脉内硫酸镁的使用随时间的变化。

结果

我们确定了在四个研究年份中，没有低钾血症的 24418 例 AMI 患者入院。随着时间的推移，静脉内硫酸镁的使用显著下降，从 2001 年的 32.1%下降到 2015 年的 17.1%（趋势 p<0.001）。东部（从 33.3%降至 16.5%）和西部（从 34.8%降至 17.2%）地区的下降幅度大于中部地区（从 25.9%降至 18.1%），农村和城市地区之间没有差异。使用静脉内硫酸镁的医院比例随时间变化不大（从 81.3%降至 77.9%）。代表医院水平变化的中位数 OR 分别为 2001 年 6.03、2006 年 3.86、2011 年 4.26 和 2015 年 4.72。静脉内硫酸镁的使用与入院时心脏骤停和接受再灌注治疗相关，但与医院特定特征无关。