2001年至2011年中国西部农村ST段抬高型心肌梗死诊疗变化趋势——China PEACE回顾性急性心肌梗死研究

Trends of ST-segment Elevation Myocardial Infarction in Western Rural China From 2001 to 2011——China PEACE Retrospective Acute Myocardial Infarction Study

目的：评价2001年~2011年中国西部农村ST段抬高型心肌梗死（STEMI）住院患者在临床特征、诊疗模式和结局方面的变化趋势。方法：采用两阶段随机抽样方式。第一阶段,采用分层随机抽样确定西部农村协作医院。第二阶段,采用系统随机抽样方法确定研究病历样本,以5年为间隔选取2001年、2006年和2011年三个时间点作为研究年份,抽取三个年份的住院病历,提取临床诊疗信息。分别对每年度的研究数据进行加权计算,以调整不同抽样概率的影响。所有结果均为加权结果,反映西部农村的整体情况。结果：抽取确定35家西部农村医院中的32家,入选1 028份STEMI病历。2001年~2011年,STEMI住院患者的中位年龄由64（54~70）岁升至67（56~75）岁（趋势P值〈0.05）,性别构成无明显差异。心血管病危险因素如高血压、血脂异常和吸烟在STEMI患者中的比例明显上升。在无相应禁忌证的患者中,入院24 h内阿司匹林使用率由2001年73.6%升至2011年89.9%,氯吡格雷使用率由0%升至66.5%,β受体阻滞剂使用率由25.4%升至64.3%,他汀类药物使用率由7.5%升至89.8%（趋势P值均〈0.01）。10年间基本无患者接受急诊经皮冠状动脉介入术,从2001年0%至2011年0.3%（趋势P值=0.51）;溶栓治疗比例由33.4%升至55.4%（趋势P值〈0.01）,2001年、2006年和2011年再灌注治疗率分别是33.4%、50.7%和55.7%（趋势P值〈0.01）。2001年、2006年和2011年住院7 d内病死率分别为3.0%、10.1%和6.7%,死亡加放弃治疗率分别为5.3%、12.3%和10.9%,调整后住院7 d内病死率和死亡加放弃治疗率变化均无统计学意义。结论：2001年~2011年,我国西部农村的STEMI患者医疗质量取得了大幅改善,使其与全国其他地区的差距显著缩小,但仍然存在明显不足。

Objective： To assess the trends in clinical characteristics and treatments for in-hospital patients with ST-segment elevation myocardial infarction（STEMI） in western rural China from 2001 to 2011.Methods： A two-stage random sampling procedure was used in our study. In 1st stage,stratified random sampling was applied to identify the participating hospitals and in 2nd stage,random sampling was applied to determine the patients to be studied. Taking 2001,2006 and 2011 as 3 time points to study the in-hospital records for STEMI treatments. The results in each year were analyzed by weighted calculation in order to adjust the proportional impact by different sampling and therefore,to reflect the entire condition in western rural area.Results： A total of 32/35 hospitals with 1028 STEMI records were enrolled. From 2001 to 2011,the admitted STEMI patients from 64（54-70） years of age increased to 67（56-75） years,Ptrend0.05,while gender composition was similar,the risk factors for cardiovascular disease such as hypertension,dyslipidemia and smoking substantially increased. Among patients without contraindications,the ues of following medications increased from 2001 to 2011： aspirin from 73.6% to 89.9%,clopidogrel from 0% to 66.5%,β-blockers from 25.4% to 64.3% and statins from 7.5% to 89.8%,all Ptrend0.01. From 2001 to 2011,the rates of primary PCI application were from 0% to 0.3%,Ptrend=0.51,the rates of thrombolytic therapy increased from 33.4% to 55.4%,Ptrend0.01. At the year of 2001,2006 and 2011,the reperfusion rates were 33.4%,50.7% and 55.4%,Ptrend0.01; the mortality within 7 days of admission were 3.0%,10.1% and 6.7%,the rates of death or treatment withdrawal because of terminal status were 5.3%,12.3% and 10.9%,there was no significant trend in the above 2 rates after adjustments.Conclusion： The quality of medical care for STEMI was significantly improved in western rural China from 2001 to 2011,while there are still gaps between western rural area and other regions.