Management of unstable angina pectoris and non-Q-wave acute myocardial infarction in the United States and Canada (the TIMI III Registry).
Management of unstable angina pectoris and non-Q-wave acute myocardial infarction in the United States and Canada (the TIMI III Registry).
复制标题
美国和加拿大不稳定心绞痛和非 Q 波急性心肌梗死的管理（TIMI III 注册）。
DOI：
10.1016/s0002-9149(97)00168-9
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Braunwald,E
中科院分区：
文献类型：
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作者：
Anderson,HV;Gibson,RS;Stone,PH;Cannon,CP;Aguirre,F;Thompson,B;Knatterud,GL;Braunwald,E
美国和加拿大对 Q 波急性心肌梗死 (AMI) 的治疗有所不同，美国进行了更多的导管插入术和血运重建手术，但临床结果几乎没有或没有明显差异。之前没有研究评估不稳定型心绞痛和非 Q 波 AMI 急性冠状动脉综合征的治疗差异。因此，我们比较了 14 个美国和 4 个加拿大三级护理中心的治疗和结果，这些中心参与了 1990 年至 1993 年间所有连续入院的不稳定心绞痛或非 Q 波 AMI 的观察登记。随机分层样本被选择用于详细评估和随访。美国中心注册了 1,733 名患者，加拿大中心注册了 642 名患者。在美国的中心，患者接受静脉注射硝酸甘油、肝素、β受体阻滞剂、钙拮抗剂或≥2种抗缺血药物的可能性较小。两国住院期间冠状动脉造影的频率相同（63.4% vs 66.9%，p = 0.781），但美国患者在 6 周和 1 年时的冠状动脉造影频率略低。冠状动脉血管成形术或搭桥手术的血运重建在 6 周和 1 年时是相同的；然而，与加拿大相比，美国的血管成形术呈减少而搭桥手术增多的趋势。美国中心的患者住院天数少于加拿大中心的患者（平均 8.2 天 vs 12.1 天，p <0.001）。 6 周时的死亡或 AMI 没有差异（4.8% vs 4.4%，p = 0.633），1 年时也没有差异（10.0% vs 10.2%，p = 0.836）。 6 周时，死亡、AMI 或复发性缺血的综合结果在美国患者比加拿大患者更常见（18.4% vs 13.9%，p = 0.004）。我们的研究结果表明，在此期间，美国医生和医院在治疗急性冠脉综合征时，并没有始终如一地利用更多资源，也没有比加拿大同行更积极。 TIMI III 登记处前瞻性研究了美国和加拿大 18 家三级医疗机构因不稳定心绞痛和非 Q 波心肌梗死入院的情况。结果表明，加拿大医院的医生在治疗这些急性冠脉综合征方面与美国医生同样积极。
Management of Q-wave acute myocardial infarction (AMI) has been shown to differ between the United States and Canada, with more catheterization and revascularization procedures performed in the United States, but with little or no apparent difference in clinical outcomes. No previous studies have evaluated management differences for the acute coronary syndromes of unstable angina pectoris and non-Q-wave AMI. We therefore compared treatments and outcomes between 14 United States and 4 Canadian tertiary care centers participating in an observational registry of all consecutive admissions for unstable angina or non-Q-wave AMI between 1990 and 1993. A random, stratified sample was selected for detailed assessment and follow-up. There were 1,733 patients enrolled in United States centers and 642 in Canadian ones. In United States centers patients were less likely to receive intravenous nitroglycerin, heparin, β blockers, calcium antagonists, or ≥2 anti-ischemic agents. Coronary arteriography during index hospitalization was equally frequent in both countries (63.4% vs 66.9%, p = 0.781), but at 6 weeks and 1 year coronary arteriography was slightly less frequent in the United States patients. Revascularization by coronary angioplasty or bypass surgery was equivalent at 6 weeks and 1 year; however, there were trends toward less angioplasty and more bypass surgery in the United States than in Canada. Patients at United States centers stayed in the hospital fewer days than patients at Canadian centers (mean 8.2 vs 12.1 days, p <0.001). Death or AMI by 6 weeks was not different (4.8% vs 4.4%, p = 0.633), nor was it different at 1 year (10.0% vs 10.2%, p = 0.836). The combined outcome of death, AMI, or recurrent ischemia was more common in United States than in Canadian patients at 6 weeks (18.4% vs 13.9%, p = 0.004). Our findings indicate that United States physicians and hospitals did not consistently utilize more resources and were not more aggressive than their Canadian counterparts when treating acute coronary syndromes during this period. The TIMI III Registry prospectively studied hospital admissions for unstable angina pectoris and non-Q-wave myocardial infarction at 18 tertiary care institutions in the United States and Canada. Results suggest that physicians at Canadian hospitals are equally aggressive as United States physicians in management of these acute coronary syndromes.