埃及ST段抬高型心肌梗死的临床表现、治疗及预后：欧洲心脏病学会ST段抬高型心肌梗死注册研究结果

Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction.

作者信息

Shaheen Sameh, Wafa Ahmad, Mokarab Mostafa, Zareef Basem, Bendary Ahmed, Abdelhameed Tarek, Rashwan Ahmad, Seleem Mohamad, Elmasry Magdy, Abdelhady Yaser, Abdelrazik Gomaa, Ibrahim Amr, Ghareeb Mohamad, Aly Khalid, Saraya Mahmoud, Wadie Moheb, Youssef Mahmoud

机构信息

Cardiology Department, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt.

Cardiology Department; Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.

出版信息

Egypt Heart J. 2020 Jul 1;72(1):35. doi: 10.1186/s43044-020-00069-x.

BACKGROUND

Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.

RESULTS

Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.

CONCLUSION

Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.

背景

除了少数小型单中心研究外，埃及关于ST段抬高型心肌梗死（STEMI）患者的数据有限。19个埃及中心（有或没有经皮冠状动脉介入治疗[PCI]设施）参与了该登记研究，共纳入1356例患者，并与来自其他欧洲心脏病学会（ESC）国家的7420例患者进行比较。本研究的目的是描述STEMI患者的特征，评估STEMI的管理模式，尤其是当前再灌注治疗的使用情况，评估埃及各地STEMI网络的组织情况，评估住院患者的结局，并将埃及患者与其他ESC国家的患者进行比较。

结果

与其他ESC国家相比，埃及患者更年轻（平均年龄55.4±11.3岁 vs. 62.9±12.4岁；p<0.001，≥75岁的患者比例为4.36% vs. 19.41%；p<0.001），女性较少（18.44% vs. 25.63%；p<0.001）。埃及症状发作至首次医疗接触的中位时间更长：120.0（60.0；240.0）分钟 vs. 100.0（50.0；240.0）分钟，p<0.001。在埃及，86.06%的患者是自行就诊而非通过急救医疗服务（EMS）就诊，而在欧盟国家这一比例为25.83%（p<0.001）。在符合条件的心电图检查中，埃及前壁STEMI的比例为57.08%，其他国家为45.98%（p<0.001）。在埃及，初始再灌注治疗中，直接PCI、溶栓治疗和未进行再灌注治疗的比例分别为49.12%、43.07%和7.26%，而在欧盟国家，这一比例分别为85.42%、7.26%和7.82%。埃及的住院死亡率为4.65%，其他国家为3.50%，p=0.040，在埃及患者中，未进行再灌注治疗的患者住院死亡率为18.87%，直接PCI患者为2.10%，溶栓治疗患者为4.97%（p<0.001）。患者出院时服用阿司匹林的比例为98.61%，氯吡格雷为91.07%，替格瑞洛为7.31%，双联抗血小板治疗为97.69%，β受体阻滞剂为82.83%，血管紧张素转换酶抑制剂为84.76%，醛固酮受体拮抗剂为10.01%，他汀类药物为99.77%。

结论

与其他ESC国家相比，埃及STEMI患者更年轻，当前吸烟者和糖尿病患者更常见，症状发作至首次医疗接触的时间更长，更多患者是自行就诊而非通过EMS就诊。溶栓治疗在埃及仍然是一种常见的再灌注治疗方法，而一半的患者接受了直接PCI治疗。埃及的住院死亡率显著更高，在未进行再灌注治疗的患者中最高，在直接PCI患者中最低。