Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2021 Jan 14;134(5):524-531. doi: 10.1097/CM9.0000000000001171.
Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.
We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.
The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.
Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
经皮冠状动脉介入治疗（PCI）应用减少与 ST 段抬高型心肌梗死（STEMI）后的死亡率升高有关。我们旨在评估中国 STEMI 患者拒绝 PCI 的潜在因素。
我们研究了中国六家公立医院急诊科诊断为 STEMI 的 957 名患者。比较了拒绝 PCI 和接受 PCI 的患者的基线特征和 30 天结局差异。多变量逻辑回归用于评估与拒绝 PCI 相关的潜在因素。
导致拒绝 PCI 的潜在因素为年龄大于 65 岁（比值比 [OR] 2.66，95%置信区间 [CI] 1.56-4.52，P<0.001）、低体重指数（BMI）（OR 0.91，95%CI 0.84-0.98，P=0.013）、未婚（OR 0.29，95%CI 0.17-0.49，P<0.001）、心肌梗死（MI）史（OR 2.59，95%CI 1.33-5.04，P=0.005）、较高的心率（HR）（OR 1.02，95%CI 1.01-1.03，P=0.002）、急诊科心源性休克（OR 5.03，95%CI 1.48-17.08，P=0.010）、院前延迟（>12 小时）（OR 3.31，95%CI 1.83-6.02，P<0.001）和未在三级医院住院（OR 0.45，95%CI 0.27-0.75，P=0.002）。与男性相比，女性年龄更大、婚姻状况更差、BMI 更低，更常被送往三级医院住院。
年龄较大、经济或社会地位较低、健康状况较差的 STEMI 患者更有可能拒绝 PCI。拒绝 PCI 的潜在预测因素存在性别差异。应针对中国 STEMI 患者采取有针对性的措施，提高其对 PCI 的接受程度。
