ST段抬高心肌梗死患者诊疗状况及预后的单中心研究

Management and prognosis in patients with ST-elevation myocardial infarction: from single-center study

关键词:  ST段抬高心肌梗死  再灌注治疗  心血管事件  预后

Key words:  ST-elevation myocardial infarction  reperfusion therapy  cardiovascular event  prognosis

摘要:

［目的］研究目前急性ST段抬高心肌梗死（STEMI）患者的发病特点、临床路径执行及预后情况。［方法］选择2009年6月1日～2010年6月1日于发病后24 h内入住大连医科大学附属第一医院的174例STEMI患者，采用统一问卷记录临床资料，并应用统一调查表在患者出院半年后进行随访。［结果］174例STEMI患者平均年龄（64.3±14.1）岁，发病时有38.5%的患者认为是心脏病，中位“症状入门时间”105 min。急诊再灌注治疗率63.2%，中位“入门溶栓时间”130 min，中位“入门球囊扩张时间”145 min。住院期间药物使用率：阿司匹林99.4%，氯吡格雷98.9%，他汀类97.7%，低分子肝素99.4%，β受体阻滞剂78.2%，血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）70.1%。住院期间病死率9.8%，其中男性病死率为6.1%，女性为20.9%（P=0.005）；≥65岁老年人病死率为18.3%，<65岁青中年为0%（P< 0.001）。中位随访时间342.5 d。随访期间药物使用率：阿司匹林92.9%、氯吡格雷60.3%、他汀类82.1%、β受体阻滞剂67.3%、ACEI/ ARB 52.6%。随访病死率为3.8%。多因素分析显示年龄是STEMI患者住院死亡的独立预测因素。［结论］STEMI发病后有较高的院前延迟，急诊再灌注治疗及出院后的循证医学药物治疗与指南仍存在一定差距。

Abstract:

［Objective］To analyze current clinical practice and outcome and prognosis of patients with ST-segment elevation myocardial infarction (STEMI). ［Methods］This was a prospective and simple-center observation study. All the 174 patients with acute STEMI admitted to the hospitals from June 1st 2009 to June 1st 2010 were included. Same questionnaire and criteria were used. The patients were followed-up for 6 months after they were discharged from the hospital. ［Results］The average age of patients was (64.3±14.1) years older. Some patients,38.5% of the all recognized the disease as heart disease. The median symptom-to-door time was 105 minutes. The proportion of selecting emergency reperfusion therapy was 63.2%. The median door-to-needle time was 130 minutes. The median door-to-balloon time was 145 minutes. In-hospital treatment included aspirin,99.4%;clopidogrel,98.9%;statins,97.7%;low molecular weight heparin,99.4%;β-blocker,78.2%;angiotensin converting enzyme inhibitor (ACEI)/ angiotensin receptor blocker (ARB),70.1%. The in-hospital mortality was 9.8%, and the mortality in females was obviously higher than that in males (20.9% vs 6.3%,P=0.005). The mortality in older patients (≥65 years old) was obviously higher than that in younger patients (18.3% vs 0%,P<0.001). Follow-up treatment were aspirin,92.9%;clopidogrel,60.3%;statins,82.1%;β-blocker,67.3%; ACEI/ARB5,2.6%. The follow-up mortality was 3.8%. Multivariate regression analysis showed that age was an independent risk factor of death in STEMI patients during hospitalization. ［Conclusions］Longer pre-hospital delay is commonly seen in STEMI patients. There is still certain gap between emergency reperfusion therapy,the evidence-based medicine agent application after discharge and related guidelines.