Amouyel P, Arveiler D, Cambou J P, Montaye M, Ruidavets J B, Bingham A, Schaffer P, Richard J L
MONICA-Lille, Service d'Epidémiologie et de Santé Publique, Faculté de Médecine et Institut Pasteur de Lille, France.
Int J Epidemiol. 1994 Aug;23(4):700-9. doi: 10.1093/ije/23.4.700.
The objective of this study was to evaluate the influence of acute coronary care on the myocardial infarction (MI) case-fatality gradient observed in three French regions. In 1989, a total of 813 hospitalized events of premature MI, occurring in men and women aged 25-64, were registered in three WHO-MONICA sites established in Lille (North of France), Strasbourg (East of France) and Toulouse (South of France). The case-fatality rates observed 28 days after the onset of the MI, were 30.6% in Lille, 17.5% in Strasbourg and 9.9% in Toulouse (P < 0.0001). We compared the management of events and the use of cardiovascular therapies in these centres before admission to hospital, during the stay and on discharge from hospital. Differences were observed between the three centres in the use of medical treatments: in Strasbourg, aspirin and antiplatelet agents were prescribed 15% less frequently, (P < 0.0001) while diuretics were prescribed twice as often as in Toulouse (P < 0.0001). Thrombolytic agents (P < 0.01) and invasive techniques (coronary angiography, coronary angioplasty and coronary bypass surgery) (P < 0.0001) were more widely used in Toulouse compared with the two other centres. Lille might have a higher rate of coronary case fatality than Strasbourg and Toulouse because of a series of cumulative characteristics. The disease presented in a more serious form: more frequent electrocardiographic changes in anterior leads (P < 0.02), higher percentage of use of inotropic drugs in association with diuretic agents (P < 0.04), and longer duration of stay in intensive care units (P < 0.0001). However, when case-fatality rates were adjusted for all these variables in a multivariate model, the rate remained significantly higher in Lille than in the two other centres (P < 0.0001), as suggested by the odds ratio (3.27, 95% confidence interval: 1.69-6.32). In conclusion, the influence of acute coronary care on the MI case-fatality gradient observed between the North and South of France is very weak.
本研究的目的是评估急性冠脉护理对在法国三个地区观察到的心肌梗死（MI）病死率梯度的影响。1989年，在位于法国北部的里尔、法国东部的斯特拉斯堡和法国南部的图卢兹设立的三个世界卫生组织MONICA监测点，共登记了813例25至64岁男性和女性住院的早发MI事件。MI发病后28天观察到的病死率，在里尔为30.6%，在斯特拉斯堡为17.5%，在图卢兹为9.9%（P<0.0001）。我们比较了这些中心在入院前、住院期间和出院时对事件的处理以及心血管治疗的使用情况。在药物治疗的使用方面，三个中心之间存在差异：在斯特拉斯堡，阿司匹林和抗血小板药物的处方频率低15%（P<0.0001），而利尿剂的处方频率是图卢兹的两倍（P<0.0001）。与其他两个中心相比，溶栓药物（P<0.01）和侵入性技术（冠状动脉造影、冠状动脉成形术和冠状动脉搭桥手术）（P<0.0001）在图卢兹使用更为广泛。里尔的冠心病病死率可能高于斯特拉斯堡和图卢兹，原因是一系列累积特征。疾病呈现出更严重的形式：前壁导联心电图改变更频繁（P<0.02），与利尿剂联合使用的强心药物使用百分比更高（P<0.04），以及在重症监护病房的住院时间更长（P<0.0001）。然而，当在多变量模型中对所有这些变量进行病死率调整时，里尔的病死率仍显著高于其他两个中心（P<0.0001），优势比表明了这一点（3.27，95%置信区间：1.69 - 6.32）。总之，急性冠脉护理对在法国北部和南部之间观察到的MI病死率梯度的影响非常微弱。
