中国不同学历ST段抬高型心肌梗死患者的临床特征和诊疗情况分析

Impact of Different Education Levels on Clinical Characteristics and Treatment Situation of Patients With ST-segment Elevation Myocardial Infarction in China

目的:探讨中国不同学历的ST段抬高型心肌梗死(STEMI)患者的人口统计学特征、危险因素、临床特征、诊疗情况及院内预后。方法:入选中国急性心肌梗死注册登记(CAMI)研究中2013年1月1日至2014年9月30日期间全国108家医院发病7 d内的12280例STEMI患者,分为低学历(包括文盲和小学)组(n=5705,46.5%)、中等学历(包括中学和中专)组(n=5161,42.0%)和高学历(大专及以上)组(n=1414,11.5%),比较各组的人口统计学特征、危险因素、临床特征、诊疗情况及院内预后。结果:与低学历组相比,中等学历组和高学历组患者年龄较小[(65.9±11.2)岁vs.(58.6±12.2)岁vs.(56.3±12.6)岁],≥3个心血管危险因素者比例较高(46.7%vs.61.4%vs.66.4%),在省级和市级医院诊治(77.7%vs.86.4%vs.93.1%)及接受急诊经皮冠状动脉介入治疗(PPCI)者比例(36.0%vs.45.2%vs.56.4%)均较高(P均<0.001)。尽管低学历组的住院死亡率高于其他两组(9.0%vs.4.7%vs.3.5%,P<0.001),但Logistic多因素回归分析显示,学历不是STEMI患者院内全因死亡的独立影响因素(低学历组vs.高学历组:OR=1.082,95%CI:0.786~1.490;中等学历组vs.高学历组:OR=1.006,95%CI:0.728~1.389;P均>0.05)。结论:与低学历组患者相比,中等学历组及高学历组患者约年轻7~10岁,且合并更多的心血管危险因素,但接受PPCI者比例较高。学历不是STEMI患者院内全因死亡的独立影响因素。

Objectives:To compare the demographic characteristics,risk factors,clinical characteristics,treatment,and in-hospital prognosis among ST-segment elevation myocardial infarction(STEMI)patients with different education levels in China.Methods:12280 patients with STEMI within 7 days of onset were enrolled from 108 hospitals nationwide between January 1,2013 and September 30,2014 in the China Acute Myocardial Infarction Registry(CAMI)study.Patients were divided into low education group who were illiterate or had primary education(n=5705,46.5%),intermediate education group who had secondary or technical secondary school education(n=5161,42.0%)and high education group who had technical college or higher education(n=1414,11.5%).The demographic characteristics,risk factors,clinical characteristics,treatment,and in-hospital prognosis were compared between the 3 groups.Results:Compared with low education group,intermediate education group and high education group had significantly younger patients([65.9±11.2]years vs.[58.6±12.2]years vs.[56.3±12.6]years),a significantly higher proportion of patients with≥3 risk factors(46.7%vs.61.4%vs.66.4%),and a higher proportion of patients who were treated in provincial and municipal hospitals(77.7%vs.86.4%vs.93.1%)and received primary percutaneous coronary intervention(36.0%vs.45.2%vs.56.4%),all P<0.001.Although in-hospital mortality was higher in low education group(9.0%vs.4.7%vs.3.5%,P<0.001),logistic multivariate regression analysis showed that education level was not an independent factor of in-hospital all-cause mortality in STEMI patients(low education group vs.high education group:OR=1.082,95%CI:0.786-1.490;intermediate education group vs.high education group:OR=1.006,95%CI:0.728-1.389;both P>0.05).Conclusions:Patients in the intermediate education group and high education group were 7-10 years younger and had more combined risk factors than those in the low education group,but the intermediate education group and high education group had a higher proportion of patients undergoing primary percutaneous coronary intervention.Education level is not an independent factor of in-hospital all-cause mortality in Chinese STEMI patients.