2001～2011年河北省急性ST段抬高型心肌梗死住院患者诊疗趋势

The Trend of Diagnosis and Treatment for In-hospital Acute ST-segment Elevation Myocardial Infarction Patients in Hebei Province From 2001 to 2011

目的:评价2001~2011年间河北省急性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:本研究数据来源于中国冠心病医疗结果评价和临床转化研究(China PEACE)回顾性急性心肌梗死(AMI)研究。采用河北省8家医院(其中三级医院1家、二级医院7家)数据进行分析。选取2001、2006和2011年3个特定年份接受住院治疗且出院诊断为STEMI的患者病历。收集数据包括患者特征、诊疗经过、用药情况及患者结局等信息。结果:8家医院的832份STEMI病历纳入本研究。2001~2011年间,STEMI住院患者的年龄增高(2001、2006和2011年中位年龄分别为63.5岁、65.0岁和66.0岁,P=0.0097);女性比例无变化(2001、2006和2011年分别为30.1%、30.7%和30.3%,P=0.9846);心血管危险因素比例增高(2001、2006和2011年分别为69.9%、87.1%和87.0%,P<0.0010)。在无相应禁忌证的患者中,再灌注治疗率无变化(P=0.8990);接受直接经皮冠状动脉介入治疗(PCI)比例无变化。药物阿司匹林、氯吡格雷、β受体阻滞剂、他汀、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)使用率升高(分别为P<0.0001、P<0.0001、P=0.0172、P<0.0001、P=0.0008)。2001、2006和2011年住院7天内病死率、死亡加放弃治疗率无变化(分别为P=0.5854、P=0.3516)。结论:河北省2001~2011年STEMI患者发病年龄、心血管病危险因素比例增高,冠心病二级预防药物使用率逐年增加,但再灌注治疗率未发生改变,STEMI患者7天内病死率未降低。

Objective： To assess trend of clinical features, diagnosis, treatments and outcomes for in-hospital patients of acute ST- segment elevation myocardial infarction （STEMI） in Hebei province from 2001 to 2011. Methods： Our research was based on the information of China PEACE retrospective acute myocardial infarction （AMI） study. We conducted an analysis from 8 hospitals in Hebei province including 1 third class hospital and 7 second class hospitals for STEMI patients who were diagnosed, treated and discharged in those hospitals in 2001, 2006 and 2011. The clinical features, process of diagnosis and treatment and outcomes were summarized. Results： A total of 832 medical records were enrolled. During 2001 to 2011, the mean age for in-hospital STEMI patients was increased as 63.5 years in 2001, 65.0 years in 2006 and 66.0 years in 2011, P=0.0097; female ratio was similar as 30.1% in 2001, 30.7% in 2006 and 30.3% in 2011, P=0.9846; the ratio for cardiovascular risk factors were elevated as 69.9% in 2001, 87.1% in 2006 and 87.0% in 2011, P〈0.0010. In patients without documented contraindications, reperfusion rate was similar, P=0.8990 and primary percutaneous coronary intervention （PCI） conduction rate was similar. The following drugtherapies were increased： aspirin （P〈0.0001）, clopidogrel （P〈0.0001）, 13-blockers （P=-0.0172）, statins （P〈0.0001） and ACEI/ ARB （P=0.0008）. In 2001, 2006 and 2011, the 7-day in-hospital mortality, the ratio of death and gave-up treatment were similar, P=-0.5854 and P=0.3516 respectively. Conclusion： During 2001 to 2011, the onset age and the prevalence of cardiovascular risk factors were increased in STEMI patients in Hebei province; drug therapy for secondary prevention of coronary artery disease was elevated by years while the reperfusion rate was similar and 7-day mortality was similar.