沙特阿拉伯ST段抬高型心肌梗死患者的主要管理策略：沙特急性心肌梗死登记研究的一项子研究
The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry.
作者信息
Kinsara Abdulhalim J, Alsaleh Ayman, Taher Ziad A, Alshamiri Mostafa, Elshaer Fayez
机构信息
Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, SAU.
Cardiology, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, SAU.
出版信息
Cureus. 2020 Nov 30;12(11):e11783. doi: 10.7759/cureus.11783.
Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a sub-study of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.
背景与目的 在沙特阿拉伯，并非所有ST段抬高型心肌梗死（STEMI）患者都接受了直接经皮冠状动脉介入治疗（PPCI）。我们分析了沙特急性心肌梗死注册研究（STARS）中STEMI患者的治疗策略。这些策略包括PPCI、溶栓治疗再灌注以及保守治疗。本研究是STARS的一项子研究。方法 将STEMI患者分为三组。第1组接受PPCI治疗，第2组接受溶栓治疗再灌注，第3组采用保守治疗方法。在患者就诊时、出院后1个月和1年收集数据。结果 样本包括1471例患者。参与者的平均年龄为54±12岁；51%为沙特公民，大多数（89%）为男性。他们的背景显示冠状动脉风险较高，48%被诊断为糖尿病（DM），44%患有高血压（HTN）；54%为现吸烟者或既往吸烟者，30%血脂较高，74%超重。42%的患者接受了PPCI治疗，29%的患者接受了溶栓治疗再灌注。29%的患者采用了保守治疗方法。因出血风险，中风患者接受了保守治疗。第1组患者大多患有高血压，有复发性心绞痛且有既往再灌注病史，接受过PPCI或冠状动脉旁路移植术（CABG）。1年时的粗全因死亡率为11%；第1组在1个月时为7%，第2组为8%，第3组为9%，差异无统计学意义。结论 控制危险因素以及改善医院PPCI的可及性是STEMI患者管理的基础。PPCI的使用仍然不足。如果无法进行PPCI，指南指导的药物治疗（GDMT）是一种合理的方法。
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