Fendrick A M, Ridker P M, Bloom B S
Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia.
Arch Intern Med. 1994 Jul 25;154(14):1605-9.
To quantify population health consequences of increased use of thrombolytic therapy for acute myocardial infarction in the United States.
A decision analytic model was constructed to evaluate treatment-related outcomes for two myocardial infarction treatment strategies: standard therapy and standard therapy plus combination aspirin-thrombolytic therapy. Patients were entered into the model by age, electrocardiographic presentation, and time to medical evaluation. Estimated mortality changes associated with increased use of thrombolytic therapy were calculated both for populations for which thrombolytic therapy is recommended and for specific patient populations for which thrombolytic therapy is not recommended under current guidelines. Sensitivity analyses tested the robustness of results when input variables were altered.
If every patient with acute myocardial infarction for whom thrombolytic therapy is recommended under current guidelines were treated with aspirin and a thrombolytic agent, more than 4000 additional lives would be saved annually in the United States. The model projected that approximately 8000 additional lives could be saved if use of thrombolytic therapy were expanded to include the following patient groups: age greater than 75 years (approximately 4500 lives saved), left bundle-branch block on electrocardiogram (approximately 2500 lives saved), and presentation 6 to 12 hours after the onset of chest pain (approximately 2000 lives saved). Sensitivity analysis demonstrated a mortality advantage attributable to the use of thrombolytic therapy in each clinical scenario tested.
Providing thrombolytic therapy more aggressively could prevent over 12,000 deaths from acute myocardial infarction each year in the United States.
量化美国增加急性心肌梗死溶栓治疗的使用对人群健康的影响。
构建一个决策分析模型，以评估两种心肌梗死治疗策略的治疗相关结果：标准治疗和标准治疗加阿司匹林-溶栓联合治疗。患者根据年龄、心电图表现和就医评估时间纳入模型。计算了推荐使用溶栓治疗的人群以及当前指南不推荐使用溶栓治疗的特定患者人群中，与增加溶栓治疗使用相关的估计死亡率变化。敏感性分析测试了输入变量改变时结果的稳健性。
如果按照当前指南推荐使用溶栓治疗的每一位急性心肌梗死患者都接受阿司匹林和溶栓剂治疗，美国每年将多挽救4000多条生命。该模型预测，如果将溶栓治疗的使用扩大到包括以下患者群体，大约可多挽救8000条生命：年龄大于75岁（约挽救4500条生命）、心电图显示左束支传导阻滞（约挽救2500条生命）以及胸痛发作后6至12小时就诊（约挽救2000条生命）。敏感性分析表明，在每个测试的临床场景中，使用溶栓治疗都有死亡率优势。
更积极地提供溶栓治疗每年可预防美国超过12000例急性心肌梗死死亡。
