开普敦基层和二级保健设施中急性冠状动脉综合征的特征和管理。
Profile and management of acute coronary syndromes at primary- and secondary-level healthcare facilities in Cape Town.
机构信息
Department of Medicine, New Somerset Hospital, Cape Town, South Africa. Email:
Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
出版信息
Cardiovasc J Afr. 2022;33(3):138-144. doi: 10.5830/CVJA-2021-054. Epub 2021 Nov 16.
BACKGROUND
Little is known about the clinical profile and management of patients with acute coronary syndromes (ACS) in the South African public sector.
METHODS
We conducted a retrospective study of patients presenting with ACS to a secondary-level healthcare facility in Cape Town during a one-year period to study the clinical profile and management of these patients.
RESULTS
Among the 214 patients in this cohort, 48 (27.5%) had ST-segment elevation myocardial infarction (STEMI), 43 (24.7%) had non-ST-segment elevation myocardial infarction and 83 (47.7%) unstable angina pectoris. We identified high rates of >12-hour delays in first medical contact after symptom onset (46%) and inaccurate ECG diagnosis of STEMI (29.2%), which were associated with low rates of thrombolysis (39.6%). High rates of non-adherence and ACS recurrence were also observed.
CONCLUSION
To address the local challenges in ACS management highlighted in this study, we propose the development of a regional referral network prioritising access to expedited care and primary reperfusion interventions in ACS.
背景
在南非公共部门中，人们对急性冠脉综合征（ACS）患者的临床特征和治疗方法知之甚少。
方法
我们对开普敦一家二级医疗机构在一年期间内就诊的 ACS 患者进行了回顾性研究，以研究这些患者的临床特征和治疗方法。
结果
在这组 214 名患者中，48 名（27.5%）患有 ST 段抬高型心肌梗死（STEMI），43 名（24.7%）患有非 ST 段抬高型心肌梗死，83 名（47.7%）患有不稳定型心绞痛。我们发现首次医疗接触出现症状后超过 12 小时的延迟（46%）和不准确的 STEMI 心电图诊断（29.2%）发生率较高，这与溶栓治疗率较低（39.6%）有关。还观察到较高的不遵医嘱和 ACS 复发率。
结论
为了解决本研究中强调的 ACS 管理方面的本地挑战，我们建议建立一个区域转诊网络，优先考虑获得快速治疗和 ACS 中进行直接再灌注干预的机会。
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