2001、2006和2011年北京市三家医院ST段抬高型心肌梗死诊疗情况趁势——China PEACE回顾性急性心肌梗死研究

摘要

Objective:To assess trends in clinical characteristics,treatments,and outcomes for hospitalized patients with ST-segment elevation myocardial infarction (STEMI) in 3 hospitals of Beijing in 2001,2006 and 2011.Methods:We selected patients admitted to 3 hospitals for STEMI in 3 years (2001,2006 and 2011) to represent the overall situation.Patient information was obtained from medical record via central abstraction.Results:590 STEMI patients from 3 hospitals were included in this analysis.Between 2001 and 2011,the median age of STEMI patients increased from 64 to 68 (Ptrend =0.0215).A gradual increase was seen in the prevalence of cardiovascular risk factors.Among patients without documented contraindications,the proportion of patients who received reperfusion did not change significantly.Significant increases were noted in use of clopidogrel (0.7％ in 2001,82.2％ in 2011),statins (52.9％ in 2001,91.4％ in 2011) within 24h.Significant increases were noted in use of aspirin (94.1％ in 2001,77.3％ in 2011),β blockers (82.9％ in 2001,67.3％ in 2011).The median length of hospital stay decreased from 14 days in 2001 to 10 days in 2011 (P =0.0014).The mortality rates within 7 days following admission were 15％,21％,19％,and the proportions of death or treatment withdrawal were 16％,24％,23％ in 2001,2006 and 2011,respectively.After adjustment,both rates did not change significantly.Conclusion:During the past decade in 3 hospitals of Beijing,the application of reperfusion did not change significantly.There are still large rooms for improvement,and the outcomes of patients have not been improved.%目的:评价2001、2006和2011年,北京市三家医院ST段抬高型心肌梗死(STE MI)住院患者在临床特征、诊疗模式和结局方面的变化趋势.方法:通过调查北京市3家协作医院,2001、2006、2011三个特定年份的研究病历,提取临床信息并进行分析.结果:共纳入3家协作医院的590份STEMI病历.2001-2011年,STEMI住院患者中位年龄由64岁上升到68岁(趋势P=0.0215),心血管危险因素比例呈上升趋势.在无相应禁忌证的患者中,再灌注治疗率无明显变化.24h内氯吡格雷由0.7％上升至82.2％(趋势P＜0.0001)、他汀由52.9％上升至91.4％(趋势P＜0.0001).24h内阿司匹林使用率由94.1％下降至77.3％(趋势P＜0.0001)、β受体阻滞剂由82.9％下降至67.3％(趋势P=0.0128).平均住院时长呈下降趋势,分别为14d、10d、10d(趋势P=0.0014).2001、2006和2011,年住院7d内病死率分别为15％、21％、19％,死亡加放弃治疗率分别为16％、24％、23％,调整后两者变化均差异无统计学意义.结论:2001、2006和201 1年,北京市三家医院STEMI住院患者人数不断增加,再灌注治疗率无明显变化,整体诊疗情况与指南推荐之间还存在明显差距,患者结局并未改善.