中国急性心肌缺血综合征患者临床特征

The clinical characteristics of acute coronary syndrome in China

目的 分析中国地区急性心肌缺血综合征病人的临床特点和治疗现状。方法 此项研究为国际性多中心关于急性心肌缺血综合征登记试验 (OASIS)的一部分。采用加拿大心血管合作协会统一设计的病例记录表 (CRF) ,自 1999年 4月开始 ,收集因急性心肌缺血入院病人的资料 ,记录病人主要临床特征和院内事件。结果 来自中国 38家医院急性心肌缺血综合征 (包括不稳定心绞痛及非Q波心肌梗死 )病人 2 2 90例 ,平均年龄 6 2 8岁 ,男性占 6 2 3%。就诊时胸痛仍未缓解者4 8 9% ;心电图异常 89 7% ,其中 4 1 4 %为相邻导联ST压低≥ 2mm ;入院诊断不稳定心绞痛90 9% ,非Q波心肌梗死 9 0 %。住院期间溶栓 3 3% ,冠状动脉 (冠脉 )造影 34 9% ,经皮冠脉腔内成形术 (PTCA) 17 6 % ,冠脉旁路移植术 (CABG) 4 2 % ,应用硝酸酯剂 99 3% ,抗血小板治疗 94 5 %。院内发生重要并发症 15 2 % ,其中死亡 1 4 %。结论 中国地区急性心肌缺血病人以不稳定心绞痛就诊居多。住院期间PTCA治疗率相对较高 ,CABG治疗率较低。

Objective To analyse the characteristics of and the therapeutic measures for patients with acute ischemic syndromes in China Method This study is a part of an international multicentre registry——the Organization to Assess Strategies for Ischemic Syndromes (OASIS) Since April 1999, the data of patients admitted to hospital with acute ischemic cardiac chest pain have been collected by filling Case Report Forms offered by the Canadian Cardiovascular Collaboration The main clinical characteristics of the patients and in hospital events were recorded Results Two thousand two hundred and ninty cases of acute ischemic syndromes from 38 hospitals throughout the nation were enrolled in the registry (include unstable angina and non Q wave myocardial infarction) The mean age of the patients was 62 8 The percentage of patients with chest pain at presentation and abnormal ECG was 48 9% and 89 7%, respectively The clinical diagnosis at admission was unstable angina (UA) in 90 9% of the patients and non Q wave myocardial infarction (non Q wave MI) in the remaining 9 0% During hospitalization the intervention procedures performed were as follows: thrombolytic therapy (TT) in 75 cases (3 3%), coronary angiography (CA) in 798 cases (34 9%), percutaneous transluminal coronary angioplasty (PTCA) in 403 cases (17 6%) and coronary artery bypass graft surgery (CABG) in 97 cases (4 2%) Nitrates (oral or patch) and anti platelet therapy were used in 2 212 cases (96 6%) and 2 163 cases (94 5%), respectively The incidence of major in hospital events was 15 2%, including 31 deaths (1 4%) Conclusion The patients with acute ischemic syndromes were diagnosed as unstable angina mostly in China A relatively high PTCA rate but low CABG rate were noted in China The most common cause of in hospital death is severe arrhythmias or sudden death