Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006
Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006
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DOI：
10.1001/jama.297.17.1892
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发表时间：
2007-05-02
影响因子：
120.7
通讯作者：
Gore, Joel M.
中科院分区：
文献类型：
--
作者：
Fox, Keith A. A.;Steg, Philippe Gabriel;Gore, Joel M.
随机试验为st段抬高和非st段抬高急性冠脉综合征（NSTE ACS）患者的药物和介入治疗的影响提供了强有力的证据，但这是否转化为临床实践的变化尚不清楚。目的探讨st段抬高型心肌梗死（STEMI）和非ste型ACS患者的医院管理改变是否与临床预后改善相关。设计、环境和患者：全球急性冠状动脉事件登记（GRACE）是一项跨国队列研究，在1999年7月1日至2006年12月31日期间，在14个国家的113家医院登记了44372名ACS患者并进行了随访。循证药物和介入治疗使用的时间趋势；患者结局（死亡、充血性心力衰竭、肺水肿、心源性休克、中风、心肌梗死）。结果在研究期间，药物的使用(受体阻滞剂、他汀类药物、血管紧张素转换酶抑制剂、噻吩吡啶伴或不伴经皮冠状动脉介入治疗[PCI]、糖蛋白IIb/IIIa抑制剂、低分子肝素
Context Randomized trials provide robust evidence for the impact of pharmacological and interventional treatments in patients with ST-segment elevation and non - ST-segment elevation acute coronary syndromes (NSTE ACS), but whether this translates to changes in clinical practice is unknown.Objective To determine whether changes in hospital management of patients with ST-segment elevation myocardial infarction (STEMI) and NSTE ACS are associated with improvements in clinical outcome.Design, Setting, and Patients In the Global Registry of Acute Coronary Events ( GRACE), a multinational cohort study, 44 372 patients with an ACS were enrolled and followed up in 113 hospitals in 14 countries between July 1, 1999, and December 31, 2006.Main Outcome Measures Temporal trends in the use of evidence-based pharmacological and interventional therapies; patient outcomes ( death, congestive heart failure, pulmonary edema, cardiogenic shock, stroke, myocardial infarction).Results Use of pharmacological medications increased over the study period (beta-blockers, statins, angiotensin-converting enzyme inhibitors, thienopyridines with or without percutaneous coronary intervention [PCI], glycoprotein IIb/IIIa inhibitors, low-molecular-weight heparin; all P