Regional outcomes after admission for high-risk non ST-segment elevation acute coronary syndromes
Regional outcomes after admission for high-risk non ST-segment elevation acute coronary syndromes
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DOI：
10.1016/j.amjmed.2006.01.018
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发表时间：
2006-07-01
影响因子：
5.9
通讯作者：
Ohman, E. Magnus
中科院分区：
文献类型：
--
作者：
Menon, Venu;Rumsfeld, John S.;Ohman, E. Magnus
目得：美国非ST段抬高急性冠状动脉综合征患者治疗和预后的地区差异分析（NSTE ACS）以前没有进行过。我们评估了56年的当代实践和结果，466例NSTE ACS高危患者2001年1月1日至9月30日，美国四个地区的310家医院收治的（阳性心脏标志物和/或缺血性ST段改变），2003.患者临床特征，急性（< 24小时）和出院药物，在医院的程序，并在医院的病死率进行了评估。基线特征（包括年龄、性别、糖尿病、高血压和吸烟率）以及药物治疗（包括β受体阻滞剂、氯吡格雷、和他汀类药物的使用情况。各地区的校正血运重建率相似。总的住院病死率为4.1%，其中中西部最高（4.6%），东北部最低（3.5%）。调整优势比（OR）（死亡的95%置信区间[CI]在中西部（OR 1.42，CI 1.19-1.70），西部（OR 1.42，CI 1.19-1.70）（OR 1.40 CI 1.05-1.87），以及南方（OR 1.33，CI 1.08-1.62）。结论：在美国，NSTE ACS高危患者的管理相对统一。然而，不同地区的住院病死率差异很大，并且无法通过标准临床变量的调整来解释这种差异。(c)2006年爱思唯尔公司All rights reserved.
PURPOSE: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed.SUBJECTS AND METHODS: We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (< 24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated.RESULTS: Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case- fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast.CONCLUSIONS: Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case- fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables. (c) 2006 Elsevier Inc. All rights reserved.