中国ST段抬高的急性心肌梗死临床特征及治疗现状

Clinical characteristics and management of patients with ST segment elevation myocardial infarction in China: survey of 7510 cases

目的分析中国ST段抬高心肌梗死(STEMI)的基线特征及治疗现状。方法作为国际多中心试验CREATE研究的一部分,2001年7月至2004年7月入选症状出现12小时内的STEMI病人,分析基线特征及治疗现状。结果中国274中心入选7510例病人,STEMI病人中0.7%为新出现的左束支传导阻滞。平均年龄62.7岁。11.5%接受PCI治疗,溶栓治疗52.5%,冠状动旁路移植术0.1%,总体接受再灌注治疗(包括溶栓及直接PCI)为62.4%。其他药物治疗情况与以往的登记研究相似。7天的死亡、卒中、再梗死联合终点为10.3%。30天总死亡率为11.1%。结论与全组急性冠脉事件登记研究相比较;中国STEMI病人的发病年龄与之相类似,伴发高血压者较多,有糖尿病史者稍少,接受再灌注率相似。但在再灌注治疗及药物治疗上还存在进一步改善的空间。

Objective To analyze the clinical characteristics and management of the patients with ST segment elevation myocardial infarction （STEMI） in China. Methods As part of the international multicentre CREATE Study, the clinical data of 7510 patients with STEMI presenting their symptoms within 12 hours of onset who were hospitalized in 274 centers throughout China from July 2001 through July 2004,aged 62. 7, were collected to be analyzed. Results 99. 3% of these patients had STEMI, and 0. 7% had new left bundle-branch block. 11.5% of them underwent percutaneous coronary intervention（ PCI）, 52. 5% underwent thrombolytic therapy , and 0. 1% coronary artery bypass grafting. All types of reperfusion therapy were carried out to 62.4% of the patients during the hospitalization. The medication therapy used was similar to those in the previous Registry report. The composite of all-cause mortality, re-infarction, and stroke within the first 7 days was 10. 3% and the all-cause mortality within 30 days was 11.1%. Conclusion The clinical characteristics and management of the STEMI patients in China have been described. The age of onset of STEMI is 62 years on average. The most common complication is hypertension, and diabetes mellitus is relatively rare. rt-PA was used rarely mainly because of the expensive price. A large proportion of patients in China receive reperfusion, which is worth recommendation. Active intervention should be carried out in the early stage after infarction.