溶栓治疗结果与医院规模及侵入性心脏治疗服务的关系。国际组织型纤溶酶原激活剂/链激酶死亡率试验的研究者们

Outcome of thrombolytic therapy in relation to hospital size and invasive cardiac services. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial.

作者信息

Barbash G I, White H D, Modan M, Diaz R, Hampton J R, Heikkila J, Kristinsson A, Moulopoulos S, Paolasso E A, Van der Werf T

机构信息

Department of Cardiology, Tel Aviv-Elias Sourasky Medical Center, Israel.

出版信息

Arch Intern Med. 1994 Oct 10;154(19):2237-42.

PMID:7944845

Abstract

OBJECTIVE

The outcome of patients with acute myocardial infarction who received thrombolytic therapy was assessed in relation to the size and comprehensiveness of cardiovascular services in the admitting hospitals.

METHODS

Two characteristics were obtained for each of the 438 hospitals: number of beds and in-house availability of cardiovascular services (coronary catheterization laboratory and coronary angioplasty or bypass surgery). Hospitals were grouped into four categories on the basis of size (< or = 300 vs > 300 beds) and availability of cardiovascular services. Baseline and outcome variables were compared by chi 2 analysis and logistic regression. Patients were followed up for 6 months.

RESULTS

Baseline variables were comparable among hospital categories except for significant differences in the distribution of antecedent angina and time to treatment. Significantly more coronary angioplasties and bypass surgeries were performed in patients first treated in hospitals with coronary revascularization services (4.1% and 4.2% vs 1.0% and 1.9%, P < .0001). Rates of strokes (1.9% vs 1.3% and 1.6%, P = .54), hospital mortality (11.9% vs 8.5%, (P = .11), and 6-month mortality (17.0% vs 11.8% and 12.3%, P = .03) were highest among patients treated in small hospitals that had coronary revascularization facilities. The rate of invasive procedures was higher in the smaller hospitals (odds ratio [OR], 1.44; 95% confidence limits [CL], 1.11 and 1.87; P = .006) and in hospitals with coronary revascularization services (OR, 4.05; 95% CL, 3.14 and 5.22; P < .0001); hemorrhage was more frequent in centers with coronary revascularization facilities (OR, 1.39; 95% CL, 1.13 and 1.71; P = .002). Rates of hospital mortality and 6-month mortality were similar.

CONCLUSIONS

Patients with acute myocardial infarction treated with thrombolytic therapy have the same mortality in small centers without in-house coronary revascularization services as in larger centers with such services.

摘要

目的

评估接受溶栓治疗的急性心肌梗死患者的治疗结果与收治医院心血管服务规模及全面性之间的关系。

方法

为438家医院中的每家医院获取两个特征数据：床位数以及心血管服务的内部可及性（冠状动脉导管实验室、冠状动脉血管成形术或搭桥手术）。根据规模（≤300张床位与>300张床位）和心血管服务的可及性将医院分为四类。通过卡方分析和逻辑回归比较基线变量和结果变量。对患者进行6个月的随访。

结果

除既往心绞痛分布和治疗时间存在显著差异外，各医院类别间的基线变量具有可比性。在首先于具备冠状动脉血运重建服务的医院接受治疗的患者中，进行冠状动脉血管成形术和搭桥手术的比例显著更高（4.1%和4.2% vs 1.0%和1.9%，P<.0001）。在具备冠状动脉血运重建设施的小型医院接受治疗的患者中，中风发生率（1.9% vs 1.3%和1.6%，P = .54）、医院死亡率（11.9% vs 8.5%，P = .11）以及6个月死亡率（17.0% vs 11.8%和12.3%，P = .03）最高。小型医院（优势比[OR]，1.44；95%置信区间[CL]，1.11和1.87；P = .006）以及具备冠状动脉血运重建服务的医院（OR，4.05；95% CL，3.14和5.22；P<.0001）的侵入性操作率更高；在具备冠状动脉血运重建设施的中心，出血更为常见（OR，1.39；95% CL，1.13和1.71；P = .002）。医院死亡率和6个月死亡率相似。