Rosamond W D, Shahar E, McGovern P G, Sides T L, Luepker R V
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27514, USA.
Am J Cardiol. 1996 Aug 1;78(3):271-7. doi: 10.1016/s0002-9149(96)00276-7.
Between 1990 and 1993, patient selection and relative effectiveness of thrombolytic agents were issues for clinical trials of thrombolytic therapy, particularly the Third International Study of Infarct Survival (ISIS-3) and the Second Gruppo Italiano per Lo Studio della Streptochinasi nell'Infarto Miocardico trials. The purpose of this report is to document the use of coronary thrombolytic therapy in community hospital practice during this period. Patients admitted to the coronary care unit of 6 hospitals with suspect acute myocardial infarction (AMI) between 1990 and 1993 were prospectively enrolled in the Minnesota Heart Survey Registry. Of the 1,225 patients with AMI enrolled, 310 men (37%) and 103 women (26%) received thrombolytic therapy (p < 0.001). The age-adjusted male-to-female odds ratio (95% confidence interval) for receiving thrombolysis among patients with < or = 12 hours since symptom onset was 1.33 (0.94, 1.87). The proportion of those treated receiving tissue plasminogen activator declined from 196 (64%) to 102 (34%) between 1990 and 1991 and 1992 and 1993. Use of streptokinase increased from 48 (16%) to 156 (52%) during the same time period. There were no statistically significant gender or lytic agent type differences in complications from thrombolytic therapy. Changes in type of agent used coincided with the release of results from the ISIS-3 trial.
1990年至1993年间，患者选择和溶栓药物的相对有效性是溶栓治疗临床试验的问题，尤其是第三次国际心肌梗死生存研究（ISIS - 3）和第二次意大利心肌梗死链激酶研究组试验。本报告的目的是记录这一时期社区医院实践中冠状动脉溶栓治疗的使用情况。1990年至1993年间，6家医院冠心病监护病房收治的疑似急性心肌梗死（AMI）患者被前瞻性纳入明尼苏达心脏调查登记处。在纳入的1225例AMI患者中，310名男性（37%）和103名女性（26%）接受了溶栓治疗（p < 0.001）。症状发作后≤12小时的患者中，接受溶栓治疗的年龄调整后的男性与女性优势比（95%置信区间）为1.33（0.94，1.87）。1990年至1991年以及1992年至1993年间，接受组织纤溶酶原激活剂治疗的患者比例从196例（64%）降至102例（34%）。同期链激酶的使用从48例（16%）增加到156例（52%）。溶栓治疗并发症在性别或溶栓药物类型方面无统计学显著差异。所用药物类型的变化与ISIS - 3试验结果的发布一致。
