Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments.
Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments.
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DOI：
10.3390/jcm10010106
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发表时间：
2020-12-30
影响因子：
3.9
通讯作者：
Baron T
中科院分区：
文献类型：
--
作者：
Gard A;Lindahl B;Hadziosmanovic N;Baron T
目标：我们的目的是研究心肌梗死（MI）患者的特点，治疗和预后的心脏科（CD）以外的治疗，在CD治疗的MI患者相比。方法：本观察性研究纳入了2011年在8家瑞典医院诊断为MI的1310例患者队列。对患者的全因死亡率进行随访，直至2018年。结果：共确定了235例患者，专门在CD之外接受治疗。与CD患者相比，这些患者有更多的非心脏合并症，年龄更大（平均年龄83.7 vs. 73.1岁），1型MI更少（33.2% vs. 74.2%）。高龄和无胸痛是非CD治疗的最强预测因素。只有3.8%的非CD患者接受了冠状动脉造影检查，他们也接受了较低程度的二级预防性药物治疗，只有32.3%的患者在出院时接受了他汀类药物治疗。在30天（风险比（HR）2.28; 95%置信区间（CI）1.62-3.22）、1年（HR 1.82; 95% CI 1.39-2.36）和5年（HR 1.62; 95% CI 1.32-1.98）时，非CD患者的全因死亡率更高。结论：CD外MI治疗与不良的短期和长期预后相关。改善经皮冠状动脉介入治疗（PCI）和二级预防性药物治疗的使用可能会改善这些患者的长期预后。
Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.
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影响因子：
3.3
作者：
Ibanez, Borja;James, Stefan;Widimsky, Petr
通讯作者：
Widimsky, Petr
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通讯作者：
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通讯作者：
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