2006、2011年中国东部城市医院急性心肌梗死患者住院早期氯吡格雷应用的现状调查

Assessment of early clopidogrel therapy in patients with acute myocardial infarction in Eastern Urban China in 2006 and 2011

目的评估2006、2011年中国东部城市医院急性心肌梗死(acute myocardial infarction,AMI)患者住院早期氯吡格雷的应用变化情况,并探讨影响其使用的因素。方法基于"冠心病医疗结果评价和临床转化研究-回顾性AMI研究"所收集的2006年和2011年东部城市具有代表性的AMI患者的临床信息,评估住院早期(入院24h内)氯吡格雷的应用情况。采用广义估计方程的多水平Logistic回归模型分析影响住院早期氯吡格雷应用的因素。结果共计32家医院的4 548份AMI病历纳入研究。中位年龄为64岁,女性患者占31.8%。2006-2011年,AMI患者住院早期氯吡格雷使用率从58.1%增加到86.8%(P<0.0001)。多因素模型分析中,吸烟患者住院早期氯吡格雷应用率高于非吸烟患者(OR=1.51,95%CI:1.22~1.86,P<0.0001);相对入院时未合并胸部不适患者,入院有胸部不适的患者更易接受氯吡格雷早期治疗(OR=2.12,95%CI:1.66~2.71,P<0.0001);院内接受直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗(OR=6.47,95%CI:3.24~12.92,P<0.0001)患者氯吡格雷使用率高于未接受直接PCI治疗患者。结论过去6年间,我国东部城市AMI患者住院早期氯吡格雷应用得到显著改善,但其应用率与指南推荐之间还存在一定差距,仍存在进一步改善空间。

Objectives To describe early clopidogrel therapy in patients with acute myocardial infarction（AMI）inEastern Urban China in 2006 and 2011,and to identify factors associated with early clopidogrel therapy. Methods Based on China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of AMI,we collectedclinical information of a representative sample of hospitalized patients with AMI in 2006 and 2011. Early clopidogreltherapy was defined as initiation within 24 hours after admission. Logistic regression analysis was used to identify factorsrelated to early clopidogrel therapy. Results We identified 4548 eligible patients for early clopidogrel therapy from 32 hospitals,of which median age was 64 years old and 31.8% were female. From 2006 to 2011,usage rate of clopidogrelin early hospitalization of AMI patients increased from 58.1% to 86.8%（P〈0.0001）. In Logistic regression,smokerswere more likely to receive early clopidogrel（OR=1.51;95% CI：1.22-1.86,P〈0.0001）;Patients with chest discom-fort were more likely to receive early clopidogrel during hospitalization（OR=2.12;95% CI：1.66-2.71,P〈0.0001）;Patients receiving primary percutaneous coronary intervention（PCI）were more likely to receive early clopidogrel compared with non-primary PCI patients（OR=6.47;95% CI：3.24-12.92,P〈0.0001）. Conclusions During the past6 years in Eastern Urban China,the status of early clopidogrel applicating has improved substantially among patientswith AMI. However,gap still persistes between guideline and clinical practice.