Barron H V, Michaels A D, Maynard C, Every N R
Department of Medicine, University of California-San Francisco Medical Center, USA.
J Am Coll Cardiol. 1998 Aug;32(2):360-7. doi: 10.1016/s0735-1097(98)00225-3.
This study was undertaken to examine recent trends in the use of angiotensin-converting enzyme (ACE) inhibitor therapy in patients discharged after acute myocardial infarction (AMI) and to identify clinical factors associated with ACE inhibitor prescribing patterns.
Clinical trials have demonstrated a significant mortality benefit in patients treated with ACE inhibitors after AMI. Numerous studies have demonstrated underuse of other beneficial treatments for patients with AMI, such as beta-adrenergic blocking agents, aspirin and immediate reperfusion therapy.
Demographic, procedural and discharge medication data from 190,015 patients with AMI were collected at 1,470 U.S. hospitals participating in the National Registry of Myocardial Infarction 2.
Prescriptions for ACE inhibitor therapy at hospital discharge increased from 25.0% in 1994 to 30.7% in 1996. Patients with a left ventricular ejection fraction < or =40% or evidence of congestive heart failure while in the hospital were discharged with ACE inhibitor treatment 42.6% of the time. Of patients experiencing an anterior wall myocardial infarction and no evidence of heart failure, 26.1% of patients were discharged with this treatment. Of the remaining patients, 15.6% received ACE inhibitors at discharge. ACE inhibitors were prescribed more often to elderly and diabetic patients as well as those requiring intraaortic balloon pump placement. This therapy was given less often to patients who underwent revascularization with coronary angioplasty or coronary artery bypass graft surgery or were treated with calcium channel blocking agents.
Physicians are prescribing ACE inhibitors in patients with myocardial infarction with increasing frequency. Those patients with the greatest expected benefit receive ACE inhibitor treatment most often. However, the majority of even these high risk patients were not discharged with this life-saving therapy.
本研究旨在调查急性心肌梗死（AMI）后出院患者使用血管紧张素转换酶（ACE）抑制剂治疗的近期趋势，并确定与ACE抑制剂处方模式相关的临床因素。
临床试验已证明AMI后接受ACE抑制剂治疗的患者死亡率显著降低。大量研究表明，AMI患者对其他有益治疗的使用不足，如β-肾上腺素能阻滞剂、阿司匹林和即时再灌注治疗。
从参与心肌梗死全国注册研究2的1470家美国医院收集了190015例AMI患者的人口统计学、手术和出院用药数据。
出院时ACE抑制剂治疗的处方率从1994年的25.0%增至1996年的30.7%。左心室射血分数≤40%或住院期间有充血性心力衰竭证据的患者，42.6%在出院时接受了ACE抑制剂治疗。前壁心肌梗死且无心力衰竭证据的患者中，26.1%在出院时接受了该治疗。其余患者中，15.6%在出院时接受了ACE抑制剂治疗。ACE抑制剂在老年患者、糖尿病患者以及需要主动脉内球囊泵置入的患者中处方更为频繁。接受冠状动脉成形术或冠状动脉旁路移植术血运重建或接受钙通道阻滞剂治疗的患者接受这种治疗的频率较低。
医生给心肌梗死患者开ACE抑制剂的频率越来越高。那些预期获益最大的患者接受ACE抑制剂治疗的频率最高。然而，即使是这些高危患者中的大多数出院时也未接受这种挽救生命的治疗。
