Naegeli B, Bertel O, Urban P, Angehrn W, Siegrist P, Stauffer J C, Baumann P C, Jolliet P, Simeon-Dubach D, Meier B, Wunderlin R
Kardiologische Abteilung, Medizinische Klinik, Stadtspital Triemli, Zürich.
Schweiz Med Wochenschr. 1998 May 9;128(19):729-36.
The aim of the PIMICS project was to create, for the first time in Switzerland, a registry of data concerning epidemiology and therapy in patients hospitalised for acute myocardial infarction covering all regions of the country. During 1995/96 73 Swiss hospitals of all categories took part in the PIMICS project. The ratio between males and females in the 3877 registered patients was 2.6:1 (2791 men vs. 1086 women). Female patients were significantly older than males (70.4 +/- 12.0 years vs. 63.4 +/- 12.6 years; p < 0.0001). The prevalence of risk factors differed between men and women: significantly more women had hypertension or diabetes, whereas smoking was more prevalent in males. The median delay between onset of symptoms and arrival at the hospital was 5.5 hours. Thrombolysis and primary angioplasty were more frequently performed in men (40.4% vs. 31.2% in women, p < 0.0001, and 5.7% in men vs. 3.5% in women, p = 0.005 respectively). During the acute phase males were treated more frequently with betablockers. The overall in-hospital mortality was 9.1%. It was significantly higher in female patients (13.5% vs. 7.4% in men; p < 0.0001) and in patients with reinfarction (14.5% vs. 7.1%; p < 0.0001). The mean hospital stay was 12.6 +/- 5.3 days. Only 7.7% of all patients with acute myocardial infarction were discharged within 6 days. At discharge, 51.7% were treated with betablockers and 69.3% with aspirin; 44.8% received ACE-inhibitors and only 13.8% lipid-lowering drugs. Follow-up measures such as coronary angiography and/or angioplasty or bypass surgery were performed significantly more often in males (45.0% vs. 32.9%; p < 0.0001). Likewise, men were more frequently assigned to a rehabilitation program than women (38.2% vs. 32.9%; p = 0.0004). The pre-hospital delay in patients with acute myocardial infarction remains too long. Primary and secondary prevention should be intensified in high risk groups, particularly in females. Thrombolysis and primary angioplasty as mainstays of treatment in acute myocardial infarction are generally used too sparingly, especially in women. With such measures the hospital stay could be shortened further.
PIMICS项目的目标是在瑞士首次创建一个涵盖该国所有地区的急性心肌梗死住院患者流行病学和治疗数据登记册。1995/96年间，瑞士各类别的73家医院参与了PIMICS项目。在3877名登记患者中，男性与女性的比例为2.6:1（2791名男性对1086名女性）。女性患者明显比男性年龄大（70.4±12.0岁对63.4±12.6岁；p<0.0001）。男女之间危险因素的患病率有所不同：患高血压或糖尿病的女性明显更多，而吸烟在男性中更为普遍。症状出现到医院就诊的中位延迟时间为5.5小时。男性接受溶栓和直接血管成形术的比例更高（男性为40.4%，女性为31.2%，p<0.0001；男性为5.7%，女性为3.5%，p = 0.005）。在急性期，男性接受β受体阻滞剂治疗的频率更高。总体住院死亡率为9.1%。女性患者的死亡率明显更高（女性为13.5%，男性为7.4%；p<0.0001），再梗死患者的死亡率也更高（14.5%对7.1%；p<0.0001）。平均住院时间为12.6±5.3天。所有急性心肌梗死患者中只有7.7%在6天内出院。出院时，51.7%的患者接受β受体阻滞剂治疗，69.3%接受阿司匹林治疗；44.8%接受血管紧张素转换酶抑制剂治疗，只有13.8%接受降脂药物治疗。男性接受冠状动脉造影和/或血管成形术或搭桥手术等后续治疗措施的频率明显更高（45.0%对32.9%；p<0.0001）。同样，男性被分配到康复项目的频率也高于女性（38.2%对32.9%；p = 0.0004）。急性心肌梗死患者的院前延迟时间仍然过长。应加强高危人群，特别是女性的一级和二级预防。溶栓和直接血管成形术作为急性心肌梗死的主要治疗手段，总体使用过于保守，尤其是在女性中。采取这些措施可以进一步缩短住院时间。
