南阳地区某医院急性ST段抬高型心肌梗死15年诊疗趋势

15-year trend of acute ST-segment elevation myocardial infarction in Nanyang

目的评价2001~2016年南阳市中心医院住院的急性ST段抬高型心肌梗死(STEMI)患者在临床特征、诊疗模式和结局方面的变化趋势。方法随机抽取我院2001年、2006年、2011年、2016年4个年份急性心肌梗死(AMI)的住院病历,提取临床信息,分析STEMI的临床特征、诊疗模式和结局。结果本研究共抽取AMI病历758例;其中STEMI 558例,2001~2016年间,心血管危险因素中高血压、血脂异常、吸烟的比例上升(P<0.05),发病到入院的中位时间由24 h缩短至12 h(P<0.0001)。未行再灌注治疗率无明显差别,2001年38.9%,2006年16.7%,2011年35.7%,2016年38.4%(P=0.34),接受急诊经皮冠状动脉介入术(PCI)的比例由0增至39.4%(P<0.002)。24 h内阿司匹林使用率由79.2%增至96.9%(P<0.0001),氯吡格雷或替格瑞洛使用率由0增至96.9%(P<0.001),他汀类使用率由0增至96.6%(P<0.001),β受体阻滞剂的使用率由52.1%增至72.4%(P<0.001),而血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)的使用率由54.9%降至43.3%(P<0.002)。2001年、2006年、2011年、2016年死亡率分别为8%、10.2%、9.2%、7.1%(P=0.76),放弃治疗率2%、6.1%、7.3%、8.1%(P=0.53),死亡与放弃治疗率10%,16.3%,16.5%,15.2%(P=0.76)。结论 2001~2016年,该院STEMI患者医疗质量有改善,但与指南相比还存在很大差距,患者结局并未改善。

Objective To assess the trends in clinical characteristics,management and outcomes for inhospital patients with acute ST-segment elevation myocardial infarction(STEMI)of Nanyang Central Hospital from 2001 to 2016.Methods Acute myocardial infarction(AMI)patients who were admitted in Nanyang Central Hospital in 2001,2006,2011 and 2016 were randomly selected.We analyzed patients’clinical characteristics,management and outcomes of STEMI.Results 758 AMI patients including 558 STEMI were enrolled.From 2001 to 2016,the risk factors for cardiovascular disease such as hypertension,dyslipidemia and smoking substantially increased(P<0.05).The median onset time to admission shortened from 24 h to 12 h(P<0.0001).The proportion of patients who did not receive reperfusion did not change significantly,38.9%in 2001,16.7%in 2006,35.7%in 2011,38.4%in 2016(P=0.34).The rate of primary PCI application increased from 0%to 39.4%(P<0.002).Administration of aspirin within 24h increased from 79.2%to 96.9%(P<0.001).Administration of clopidogrel/ticagrelor increased from 0 to 96.9%(P<0.001).Administration of statins increased from 0 to 96.6%(P<0.0001).Administration ofβ-blockers increased from 52.1%to 72.4%(P<0.001),but the application of ACEI/ARB decreased from 54.9%to 43.3%(P<0.002).In 2001,2006,2011 and 2016,The in-hospital mortalities were 8%,10.2%,9.2%and 7.1%(P=0.76),and the rates of death or treatment withdrawal because of terminal status were 2%,6.1%,7.3%and 8.1%(P=0.53).Conclusion The quality of medical care for STEMI was improved in the hospital from 2001 to 2016,while there were still obvious gaps from the guideline.The outcomes had not change significantly.