Sussman Whitney B, Johnson Conner E, Weeda Erin R
University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Hosp Pharm. 2024 Nov 29:00185787241303485. doi: 10.1177/00185787241303485.
Fibrinolysis is more commonly used to manage ST-segment elevation myocardial infarction (STEMI) in rural versus urban areas. However, little is known about the outcomes associated with this treatment strategy in rural individuals. We sought to compare in-hospital outcomes associated with the use of fibrinolysis versus primary percutaneous coronary intervention (PCI) among patients residing in rural areas presenting with STEMI. We identified adult patients with STEMI between 2016 and 2021 using the United States National Inpatient Sample. The cohort was restricted to individuals residing in rural areas. Patients were divided into 2 cohorts based on the receipt of initial fibrinolysis versus primary PCI. In-hospital outcomes were compared between cohorts, with in-hospital mortality serving as the primary outcome and length of stay (LOS) serving as a secondary outcome. We identified 13 475 rural STEMI encounters receiving either initial fibrinolytic therapy (n = 1095) or primary PCI (n = 12 380). The average age and number of comorbidities were similar between cohorts. In-hospital mortality occurred in 5.2% of patients, and mean LOS for initial fibrinolysis and primary PCI patients was 3.73 ± 3.739 days and 3.45 ± 3.974 days, respectively. After adjusting for covariates, initial fibrinolysis was not associated with higher in-hospital mortality (odds ratio [OR] = 0.913; 95% confidence interval [CI] = 0.679-1.228). Initial fibrinolysis was associated with a small increase in LOS compared to primary PCI (Mean difference = 0.079 days; 95%CI = 0.035-0.123). In this analysis of approximately 13 000 STEMI encounters among rural individuals, patient characteristics between those treated with initial fibrinolysis versus primary PCI were similar. Observed outcomes were not meaningfully different between cohorts. Fibrinolytic therapy should not be an overlooked treatment strategy in rural STEMI patients facing delays in receipt of primary PCI.
与城市地区相比，纤维蛋白溶解疗法在农村地区更常用于治疗ST段抬高型心肌梗死（STEMI）。然而，对于农村患者采用这种治疗策略的相关结果知之甚少。我们试图比较农村地区STEMI患者使用纤维蛋白溶解疗法与直接经皮冠状动脉介入治疗（PCI）的住院结局。我们使用美国国家住院样本确定了2016年至2021年间的成年STEMI患者。该队列仅限于居住在农村地区的个体。根据接受初始纤维蛋白溶解疗法还是直接PCI，将患者分为两个队列。比较队列之间的住院结局，以住院死亡率作为主要结局，住院时间（LOS）作为次要结局。我们确定了13475例农村STEMI病例，其中接受初始纤维蛋白溶解疗法的有1095例，接受直接PCI的有12380例。队列之间的平均年龄和合并症数量相似。5.2%的患者发生了住院死亡，初始纤维蛋白溶解疗法患者和直接PCI患者的平均住院时间分别为3.73±3.739天和3.45±3.974天。在对协变量进行调整后，初始纤维蛋白溶解疗法与更高的住院死亡率无关（优势比[OR]=0.913；95%置信区间[CI]=0.679-1.228）。与直接PCI相比，初始纤维蛋白溶解疗法与住院时间略有增加相关（平均差异=0.079天；95%CI=0.035-0.123）。在这项对约13000例农村个体STEMI病例的分析中，接受初始纤维蛋白溶解疗法与直接PCI治疗的患者特征相似。队列之间观察到的结局没有显著差异。对于面临直接PCI延迟的农村STEMI患者，纤维蛋白溶解疗法不应被视为一种被忽视的治疗策略。
