中国东部城市医院急性心肌梗死患者心肌标志物检测情况十年趋势--China PEACE回顾性研究结果

Trends in Cardiac Biomarker Testing in Patients with Acute Myocardial Infarction in Hospitals in Eastern Urban China from 2001 to 2011: a China PEACE-retrospective AMI Study

目的研究2001—2011年我国东部城市医院急性心肌梗死(AMI)患者心肌标志物检测情况。方法于2011年10月—2013年6月,"冠心病医疗结果评价和临床转化研究"(China PEACE)回顾性AMI研究通过两阶段随机抽样获得临床资料:第一阶段从东部城市的最高级别医院进行随机抽样,确定协作医院;第二阶段,从每家协作医院提供的2001年、2006年和2011年出院诊断为AMI的住院患者中抽取病历。收集协作医院的基本信息及AMI患者临床资料,分析医院心肌标志物(肌酸激酶同工酶和肌钙蛋白)检测的开展情况和AMI患者心肌标志物检测率的时间变化趋势,以及在开展肌钙蛋白检测的医院中,AMI患者肌钙蛋白检测率的分布情况。结果共计32家东部城市医院,5 667份AMI病历纳入研究。2001年、2006年和2011年分别为27、29、32家医院。2001年、2006年和2011年AMI患者分别为1 003、1 579、3 085例。2001年、2006年和2011年开展任意一种心肌标志物检测的医院比例分别为96.3%(26/27)、96.6%(28/29)和100.0%(32/32),不同年份开展心肌标志物检测的医院比例比较,差异无统计学意义(检验统计量值=-0.975,P=0.330)。2001年、2006年和2011年开展肌钙蛋白检测的医院比例分别为55.6%(15/27)、79.3%(23/29)和96.9%(31/32),肌钙蛋白检测的医院比例呈逐年增长趋势(检验统计量值=-3.831,P<0.001)。2001年、2006年和2011年AMI患者心肌标志物检测率分别为83.75%(840/1 003)、90.44%(1 428/1 579)和95.79%(2 955/3 085),AMI患者心肌标志物检测率呈逐年增长趋势(检验统计量值=-12.661,P<0.001)。2001年、2006年和2011年AMI患者肌钙蛋白检测率分别为30.91%(310/1 003)、52.56%(830/1 579)和72.41%(2 234/3 085),AMI患者肌钙蛋白检测率呈逐年增长趋势(检验统计量值=-24.190,P<0.001)。2001年、2006年和2011年各医院间AMI患者肌钙蛋白检测率比较,差异均有统计学意义(χ_(2001)~2=653.145,P<0.001;χ_(2006)~2=1 080.538,P<0.001;χ_(2011)~2=1 372.946,P<0.001)。2011年,开展肌钙蛋白检测的医院中,AMI患者肌钙蛋白检测率>80.0%的仅占64.5%(20/31)。结论 2001—2011年,东部城市医院心肌标志物的检测已逐渐普及,大部分医院开展了肌钙蛋白检测,但AMI患者肌钙蛋白的检测率有待提高。东部城市医院AMI的诊疗过程存在亟待改善之处,临床实践对诊疗指南的依从性有待进一步提高。

Objective To describe the trend of biomarker testing in patients with acute myocardial infarction（ AMI）in hospitals in eastern urban China from 2001 to 2011. Methods From October 2011 to June 2013,we conducted the China Patient-Centered Evaluative Assessment of Cardiac Events（ China PEACE）-retrospective AMI study. Two-stage random sampling was used to collect the general data of the sampled hospitals and profiles of their AMI patients ： in the first stage,we identified sample hospitals using a simple random sampling from the tertiary grade A hospitals in eastern urban China; in the second stage,we drew cases discharged in 2001,2006 and 2011 based on the local hospital database for patients with AMI at each sampled hospital using systematic random sampling. Based on analyzing the data of the investigated hospital and the profiles of corresponding AMI patients,we described the temporal trends in the use of cardiac biomarker testing and proportion of AMI patients with cardiac biomarker testing in these hospitals,as well as the proportion of AMI patients with troponin testing in the hospitals with testing capability. Results Totaled 32 hospitals in eastern urban China participated in the study and 5 667 AMI patients were included in analysis of biomarker use. Number of hospitals included in 2001,2006 and 2011 was 27,29 and 32,respectively. Number of patients included in 2001,2006 and 2011 were 1 003,1 579 and 3 085,respectively. The proportion of hospitals performing the testing of any type of biomarkers were 96. 3%（ 26/27）,96. 6%（ 28/29）,100. 0%（ 32/32） in2001,2006 and 2011,respectively with no significant difference among them（ test statistic =-0. 975, P = 0. 330）. The proportion of hospitals with troponin testing capability increased significantly（ test statistic =-3. 831,P〈0. 001） year after year,which was 55. 6%（ 15/27）,79. 3%（ 23/29）,96. 9%（ 31/32） in 2001,2006 and 2011. The proportion of AMI patients undergoing biomarker testing in 2001,2006 and 2011 were 83. 75%（ 840/1 003）,90. 44%（ 1 428/1 579）,95. 79%（ 2 955/3 085）,respectively with significant difference（ test statistic =-12. 661,P〈0. 001）. The proportion of AMI patients undergoing troponin testing increased significantly（ test statistic =-24. 190,P〈0. 001） by year,which were30. 91%（ 310/1 003）,52. 56%（ 830/1 579）,72. 41%（ 2 234/3 085） in 2001,2006 and 2011,respectively. There was significant difference in the proportion of troponin testing for AMI patients among all the hospitals with troponin testing capability in 2001,2006 and 2011（ χ_（2001）~2= 653. 145,P〈0. 001; χ_（2006）~2= 1 080. 538,P〈0. 001; χ_（2011）~2= 1 372. 946,P〈0. 001）. In 2011,hospitals of which the proportion of troponin testing in AMI patients was over 80. 0% only accounted for64. 5%（ 20/31）. Conclusion During 2001 to 2011, biomarker tests for AMI diagnosis become gradually available in hospitals in eastern urban China,and troponin testing is accessible in most hospitals,but some of them need to improve the use of troponin testing in the diagnosis of AMI. And there is still room left to improve the compliance of clinical practice to guidelines in the medical care of AMI in these hospitals.