2001—2011年东部城市急性心肌梗死住院患者阿司匹林早期使用趋势研究

Trends in Early Aspirin Administration in Acute Myocardial Infarction Inpatients in Urban Areas of Eastern China from 2001 to 2011

背景阿司匹林可明确降低急性心肌梗死(AMI)患者的死亡风险,且适用范围广、效价比高,无禁忌证患者应尽早使用。东部城市AMI患者早期阿司匹林的使用情况尚不清楚。目的评价2001—2011年东部城市AMI患者早期阿司匹林使用率及变化趋势,并分析可能影响阿司匹林早期使用的因素。方法选取2001、2006及2011年3个年度,采用两阶段随机抽样方法抽取AMI病历,提取病历信息。分析患者在入院24 h内的阿司匹林使用率及10年变化趋势,采用多因素Logistic回归分析探讨其使用的影响因素。每年度分别进行加权计算,以代表东部城市整体情况。结果东部城市32家医院参加研究,随机抽取2001、2006、2011年3个年度无阿司匹林禁忌证的AMI住院患者5 522例,3个年度医院早期阿司匹林的加权使用率分别为80.3%、89.6%及90.2%(χ2趋势=1.300×10-10,P<0.01)。2011年医院早期阿司匹林的使用率最低为62.1%(36/58)。多因素Logistic回归分析结果显示,年龄≥75岁、患有糖尿病、合并心源性休克的患者较少接受早期阿司匹林治疗,入院时存在胸部不适症状、接受再灌注治疗[包括溶栓治疗或行直接经皮冠状动脉介入治疗(PCI)]、入住年份为2006年或2011年、住在有PCI能力医院的患者早期阿司匹林使用率相对较高。结论东部城市AMI住院患者早期阿司匹林使用率相对较高,2001—2011年呈上升趋势,但仍有改善空间。

Background Aspirin has been demonstrated to be a high cost-effective treatment for acute myocardial infarction（ AMI）, and is recommended to be extensively used in patients without contraindications for it as early as possible. However,the rates and recent trends of aspirin administration for the early treatment of AMI in urban areas of eastern China are still unknown. Objective To evaluate the rate and recent trends and possible associated factors of aspirin administration for the early treatment of AMI in urban areas of eastern China from 2001 to 2011. Methods We used a two-stage random sampling design to create a representative sample of patients who admitted to hospitals for AMI in urban areas of eastern China in3 study years（ 2001,2006 and 2011）. Analysis was conducted based on the patients＇ information obtained from medical records. We examined the rates and changes in trend of aspirin administration within 24 h after admission in the participants from2001 to 2011,and identified factors associated with aspirin administration with multivariate Logistic regression models. We used weighted calculation for each year to represent the overall situation. Results The enrolled participants were a total of 5 522 AMI inpatients who had no contraindications for aspirin and received early aspirin therapy in 32 hospitals in urban areas of eastern China in 2001,2006 and 2011. Early weighted average utilization rate of aspirin for AMI increased over time,80. 3% in 2001,89. 6% in 2006,and 90. 2% in 2011（ χ_（trend）~2= 1. 300 × 10^（-10）,P 0. 01）. In 2011 the lowest rate of aspirin administration in the hospitals was 62. 1%（ 36/58）. The analysis with multivariate Logistic regression models found that,aspirin was more likely to be used in patients who had chest discomfort at admission,received reperfusion therapy（ thrombolytic therapy or direct PCI therapy）,were treated in 2006 or 2011,and presented to a PCI-capable hospital. However,for patients who were elderly（ ≥75 years）,had been diagnosed with diabetes mellitus,or had cardiogenic shock seemed less likely to use this drug. Conclusion Early administration rate of aspirin in AMI patients within 24 h after admission in urban areas of eastern China is relatively high,and it presents an increasing trend from 2001 to 2011,however,there is still room for improvement.