Ozbek C, Heisel A, Krause M, Berg G, Hammer B, Bay W, Sen S, Schieffer H
Department of Internal Medicine III, University of Saarland, Homburg/Saar, Federal Republic of Germany.
Am J Cardiol. 1995 Dec 1;76(16):1103-7. doi: 10.1016/s0002-9149(99)80314-2.
Within 1 year, 434 patients were admitted to 14 hospitals with suspected acute myocardial infarction (AMI) < or = 4 hours after the onset of symptoms. Group A consisted of 171 patients (39%) treated with thrombolysis, and group B consisted of 263 patients (61%) with contraindications. Patients in group A more likely had a "definite AMI" (92%; group A1) than patients in group B (67%; group B1). Group B1 had 277 contraindications (1.6/per patient) with increased risk for life-threatening bleeding being the most frequently recorded at admission. The in-hospital mortality in group A1 was 7% (11 of 158) and in group B1, 27% (47 of 177) (p < 0.0001). Age and type of therapy (thrombolysis or no thrombolysis) were identified as independent predictors of increased mortality (p < 0.0001 and < 0.05, respectively). Thus, although most patients with an AMI are excluded from thrombolytic therapy because of contraindications, our data suggest that their in-hospital mortality is unexpectedly high. Further evaluation of this group of patients is warranted to define the impact of contraindications as an independent factor of mortality.
在1年时间里，有434例症状发作后≤4小时疑似急性心肌梗死（AMI）的患者被收治于14家医院。A组由171例（39%）接受溶栓治疗的患者组成，B组由263例（61%）有禁忌证的患者组成。A组患者比B组患者更有可能患有“确诊AMI”（92%；A1组）（67%；B1组）。B1组有277项禁忌证（人均1.6项），入院时记录最多的是危及生命出血风险增加。A1组的院内死亡率为7%（158例中的11例），B1组为27%（177例中的47例）（p<0.0001）。年龄和治疗类型（溶栓或未溶栓）被确定为死亡率增加的独立预测因素（分别为p<0.0001和<0.05）。因此，尽管大多数AMI患者因禁忌证被排除在溶栓治疗之外，但我们的数据表明他们的院内死亡率意外地高。有必要对这组患者进行进一步评估，以确定禁忌证作为死亡率独立因素的影响。
