Birkhead J S
Department of Cardiology, Northampton General Hospital, United Kingdom.
Heart. 1997 Jul;78(1):28-33. doi: 10.1136/hrt.78.1.28.
To examine use of thrombolytic drugs for myocardial infarction and use of contraindications to treatment in the United Kingdom.
Observational study, based on a continuing audit.
39 hospitals in the United Kingdom.
30,029 patients admitted between November 1992 and June 1995 with suspected myocardial infarction.
Of 13,628 patients with a final diagnosis of definite myocardial infarction 10,316 (75.7%) were considered eligible for thrombolytic treatment on the basis of typical cardiographic changes or new left bundle branch block. Of these, 8139 (59.7%) were diagnosed at admission to hospital and 6991 (85.9%) were administered thrombolytic drugs; 14.1% were considered too late for treatment or had a clinical contraindication. In 2177 patients (16% of 13,628)-thrombolytic treatment was given in the absence of contraindications and after the diagnosis of infarction had been confirmed by further electrocardiographic evidence. A further 591 (4.3%) with a final diagnosis of definite infarction without typical cardiographic changes also received thrombolytic treatment as did 1018 patients without a final diagnosis of definite infarction. In total, 9459 of 13,628 patients (71.6%) received thrombolytic treatment. The range of use of treatment between hospitals for a final diagnosis of infarction was 49.1-85.4%. This variation reflected differences in the frequency with which a diagnosis of definite myocardial infarction was made at admission, and the subsequent use of clinical contraindications to thrombolytic treatment.
75.7% of patients with a final diagnosis of definite myocardial infarction were eligible for thrombolytic treatment on the basis of cardiographic changes. Differences between hospitals in the frequency with which a diagnosis of infarction was made on admission, and differences in subsequent use of thrombolytic drugs, results in wide variation in treatment rates. Differences in use of thrombolytic treatment mainly reflect different thresholds for the use of clinical contraindications relating to haemorrhagic risk.
调查英国心肌梗死溶栓药物的使用情况以及治疗禁忌的应用情况。
基于持续审计的观察性研究。
英国39家医院。
1992年11月至1995年6月间因疑似心肌梗死入院的30029例患者。
在最终确诊为明确心肌梗死的13628例患者中，10316例（75.7%）基于典型心电图改变或新发左束支传导阻滞被认为适合溶栓治疗。其中，8139例（59.7%）在入院时被诊断，6991例（85.9%）接受了溶栓药物治疗；14.1%被认为治疗太晚或存在临床禁忌。在2177例患者（13628例中的16%）中，在无禁忌且梗死诊断经进一步心电图证据确认后接受了溶栓治疗。另有591例（4.3%）最终确诊为明确梗死但无典型心电图改变的患者也接受了溶栓治疗，还有1018例未最终确诊为明确梗死的患者也接受了溶栓治疗。总计，13628例患者中的9459例（71.6%）接受了溶栓治疗。各医院对最终诊断为梗死的患者的治疗使用率在49.1%至85.4%之间。这种差异反映了入院时明确心肌梗死诊断频率的不同，以及随后溶栓治疗临床禁忌的使用情况。
基于心电图改变，75.7%最终确诊为明确心肌梗死的患者适合溶栓治疗。各医院在入院时梗死诊断频率以及随后溶栓药物使用方面的差异，导致治疗率差异很大。溶栓治疗使用差异主要反映了与出血风险相关的临床禁忌使用的不同阈值。
