2001—2011年中西部城市ST段抬高型心肌梗死诊疗趋势

ST-segment elevation myocardial infarction in central-western urban China from 2001 to 2011:the China PEACE-retrospective acute myocardial infarction study

目的评价2001—2011年中国中西部城市ST段抬高型心肌梗死(STEMI)住院患者的临床特征、诊疗模式和结局的变化趋势。方法通过两阶段随机抽样,获得2001、2006和2011年有代表性的中西部城市STEMI住院患者样本。第一阶段,采用简单随机抽样方法确定协作医院;第二阶段,采用系统随机抽样方法,抽取协作医院3个特定年份的研究病历,以提取临床信息。对每年度分别进行加权处理。结果共计31家协作医院的3 073例STEMI病例纳入研究。2001—2011年,STEMI住院患者的年龄、性别变化均无统计学意义,2011年中位年龄63岁,女性比例24.7%。有2个心血管危险因素的患者比例从2001年的36.2%升至2011年的40.3%(趋势P值=0.031),有3个及以上心血管危险因素的患者比例从11.4%升至19.1%(趋势P值=0.001 5)。接受直接经皮冠状动脉介入术(PCI)的患者比例由2001年的0.7%增至2011年的28.2%(趋势P值<0.001);溶栓治疗比例则由63.1%降至22.8%(趋势P值<0.001)。氯吡格雷使用率由2001年的1.4%升至2011年的91.4%(趋势P值<0.001);他汀类药物由22.5%升至96.6%(趋势P值<0.001);β受体阻滞剂使用率2011年为56.9%,与2001年相比变化无统计学意义;血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂的使用率从2001年的72.5%降至2011年的68.5%(趋势P值=0.022);硫酸镁的使用率从26.7%降至20.4%(趋势P值=0.17)。肌钙蛋白检测率从2001年的12.6%增至2011年的58.2%(趋势P值<0.001)。7 d病死率2001、2006和2011年分别为8.3%、7.9%和5.4%,死亡加放弃治疗率分别为8.3%、10.3%和8.3%。经多水平Logistic回归模型调整患者人口学特征和临床特征后,7 d病死率并无下降趋势。结论 2001—2011年,中西部城市冠状动脉介入诊疗技术快速发展,新药使用大幅增长,但价格便宜、疗效明确的老药使用不足,且患者结局也并未得到改善。

Objective To evaluate trends in clinical characteristics, treatments, and outcomes for hospitalized patients with ST-segment elevation myocardial infarction (STEM I) in central-western urban China from 2001 to 2011. Methods From a two-stage random sampling, a representative sample of patients in central-western urban China admitted to hospital for STEMI in 2001, 2006 and 2011 was obtained. In the first phase, simple random sampling procedure was used to identify participating hospitals. In the second phase, we selected patients a dmitted to each sampled hospital for STEMI in above 3 years through a systematic sampling approach. Medical records were centrally abstracted to get patients? information. We weighted our findings for each year to represent the overall situation. Results We included 3 073 STEMI patients from 31 participating hospitals in this analysis. The age and gender did not change significantly from 2001 to 2011 , the median age of STEMI patients was 63 and the percentage of female was 24. 7% in 2011.Between 2001 and 2011, STEMI patients with 2 risk factors increased from 36. 2% to 40. 3% ( ^tiend =0. 031) , those with 3 or above risk factors increased from 11.4% to 19.1% (P ttend =0. 001 5 ). During this period, use of primary percutaneous coronary intervention (PCI) increased from 0. 7% to 28. 2% (P ttend <0. 00 1) , whereas the proportion of patients who received thrombolysis therapy decreased from 63.1% to 22.8% (P ttend <0. 00 1). Significant increases were noted in use of clopidogrel ( 1 .4% in 2001 to 91.4% in 2011, < 〇?〇〇 1) and statins (22.5% in 2001 to 96.6% in 2011, < 〇? 〇〇 1)- The use of pblockers did not change significantly and was 56. 9% in 2011. The uses of ACEI/ARB decreased from72.5% in 2001 to 68.5% in2011 ( P ^ ^ k Q.QH). The use of magnesium sulfate decreased from 26. 7%in 2001 to 20. 4% in 2011 ( P ttend =0. 17). The mortality rates within 7 days following admission were8 .3 % , 7 .9 % , 5 .4 % , and the proportions of death or treatment withdrawal were 8 .3 % , 10. 3% , 8.3% in 2001, 2006 and 2011, respectively. After adjustment, both rates did not change significantly. Conclusions Between 2001 and 2011 in central-western urban China, the application of PCI and novel drugs were increased dramatically. However, cheap effective old drugs were underused. The outcomes of patients have not been improved.