Management of ST-segment elevation myocardial infarction in predominantly rural central China: A retrospective observational study.
Management of ST-segment elevation myocardial infarction in predominantly rural central China: A retrospective observational study.
复制标题
主要中国中部农村地区的ST段海拔心肌梗死的管理：一项回顾性观察性研究。
DOI：
10.1097/md.0000000000005584
复制
发表时间：
2016-12
期刊：
影响因子：
1.6
通讯作者：
Duan G
中科院分区：
文献类型：
--
作者：
Zhang Y;Yang S;Liu X;Li M;Zhang W;Yang H;Hu D;Gao C;Duan G
发达国家和中国大城市对现行 ST 段抬高型心肌梗死 (STEMI) 临床治疗指南的遵守程度是众所周知的，但在主要农村地区缺乏信息。我们评估了河南省二级和三级医院早期再灌注治疗 STEMI 的应用情况。回顾性收集河南省5家二级医院和4家三级医院2011年1月至2012年1月收治的STEMI患者的治疗策略、延误时间、院内死亡率等数据。 1311例STEMI患者中，二级和三级医院分别有613例和698例接受治疗。总体而言，460例（35.1%）患者接受了早期再灌注治疗，其中溶栓治疗383例，初次经皮冠状动脉介入治疗77例。与二级中心相比，三级医院的早期再灌注（37.2% vs 32.6%）和成功再灌注（34.5% vs 25.1%）显着较高，而溶栓治疗则较低（26.4% vs 32.5%）。症状出现到首次医疗接触、上门到注射和上门到球囊的时间中位分别为 168 分钟、18 分钟和 60 分钟。延误时间非常接近推荐的指南，尤其是在二级中心。推荐药物治疗的使用率较低，特别是在二级医院。院内死亡率为 5.8%，二级和三级医院之间的死亡率相似（6.0% vs 5.6%；P = 0.183）。三分之二的STEMI患者没有接受早期再灌注，三级医院大多未能利用全天候的直接经皮冠状动脉介入治疗。需要采取转诊等行动来缩短院前延误时间，并且应解决患者和医生对再灌注风险的担忧。
The degree of adherence to current guidelines for clinical management of ST-segment elevation myocardial infarction (STEMI) is known in developed countries and large Chinese cities, but in predominantly rural areas information is lacking. We assessed the application of early reperfusion therapy for STEMI in secondary and tertiary hospitals in Henan province in central China. Data were retrospectively collected from 5 secondary and 4 tertiary hospitals in Henan concerning STEMI patients treated from January 2011 to January 2012, including management strategy, delay time, and inhospital mortality. Among 1311 STEMI patients, 613 and 698 were treated at secondary and tertiary hospitals, respectively. Overall, 460 (35.1%) patients received early reperfusion therapy including thrombolysis in 383 patients and primary percutaneous coronary intervention in 77. Compared with secondary centers, early (37.2% vs 32.6%) and successful reperfusion (34.5% vs 25.1%) was significantly higher, whereas thrombolysis was lower in the tertiary hospitals (26.4% vs 32.5%). Median symptom onset-to-first medical contact, and door-to-needle and door-to-balloon time was 168, 18, and 60 minutes, respectively. Delay times closely approached recommended guidelines, especially in secondary centers. Use of recommended pharmacotherapy was low, particularly in secondary hospitals. Inhospital mortality was 5.8%, and similar between secondary and tertiary hospitals (6.0% vs 5.6%; P = 0.183). Two-thirds of STEMI patients did not receive early reperfusion, and tertiary hospitals mostly failed to take advantage of around-the-clock primary percutaneous coronary intervention. Actions such as referrals are warranted to shorten prehospital delay, and the concerns of patients and doctors regarding reperfusion risk should be addressed.