早期静脉使用硝酸甘油治疗急性心力衰竭患者：来自 EAHFE 西班牙登记处的见解。
Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry.
机构信息
Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global Research in Acute Contditions Team) Network, Via Antonio Serra 54, 00191, Roma, Italy.
Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain.
出版信息
Int J Cardiol. 2021 Dec 1;344:127-134. doi: 10.1016/j.ijcard.2021.09.031. Epub 2021 Sep 20.
BACKGROUND AND OBJECTIVE
Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients.
METHODS
We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group.
RESULTS
We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower in-hospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings.
CONCLUSIONS
Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF.
背景与目的
尽管静脉内（IV）硝酸甘油（NTG）被推荐用于治疗急性心力衰竭（AHF），但其应用的证据却很少且相互矛盾。在本次分析中，我们评估了由急救医疗服务（EMS）或在急诊科（ED）开始给予 IV NTG 对 AHF 患者结局的影响。
方法
我们分析了由 45 家医院送入 ED 的 AHF 患者。根据患者在进入 ED 前（预 ED-NTG）、ED 期间（ED-NTG）或未接受 IV NTG 治疗（无-NTG，对照组）开始接受 IV NTG 治疗的情况将患者分组。比较 EMS-NTG 和 ED-NTG 组与对照组的院内、30 天和 365 天全因死亡率、延长住院时间（>7 天）和 90 天出院后复合不良事件（ED 再就诊、住院或死亡）。
结果
共纳入 8424 例患者：预 ED-NTG=292（3.5%）、ED-NTG=1159（13.8%）和无-NTG=6973（82.7%）。预 ED-NTG 组 AHF 病情最严重（p<0.001），但院内（OR=0.724，95%CI=0.459-1.114）、30 天（HR=0.818，0.576-1.163）和 365 天死亡率（HR=0.692，0.551-0.869）和 90 天出院后事件（HR=0.795，0.643-0.984）均低于对照组。ED-NTG 组的死亡率与对照组相似（院内：OR=1.164，0.936-1.448；30 天：HR=0.980，0.819-1.174；365 天：HR=0.929，0.830-1.039），但显著降低了 90 天出院后事件（HR=0.870，0.780-0.970）。各组延长住院率无差异。五项不同的分析均证实了这些发现。
结论
早期院前 IV NTG 给药与较低的死亡率和出院后事件相关，而仅在 ED 开始 IV NTG 可改善出院后事件发生率。需要进一步研究来评估早期院前给予 IV NTG 对 AHF 患者的作用。
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