Demographics, treatment and outcome of acute coronary syndromes:: 17 years of experience in a specialized cardiac centre
Demographics, treatment and outcome of acute coronary syndromes:: 17 years of experience in a specialized cardiac centre
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DOI：
10.1016/s0828-282x(06)70250-1
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发表时间：
2006-02-01
影响因子：
6.2
通讯作者：
Nigam, A
中科院分区：
文献类型：
--
作者：
Awaida, JPS;Dupuis, J;Nigam, A
背景：在专门的心脏中心管理的急性冠脉综合征患者的流行病学信息是有限的。目的：报告17年来三级冠状动脉监护病房（CCU）住院患者的人口统计学、治疗和预后的演变。方法：对1986年4月至2003年3月在某21床CCU住院的18719例患者的前瞻性数据库进行分析。结果：从1986年到2003年，住院人数从937人/年增加到1577人/年，住院时间从7.5天/年减少到3.5天/年。平均年龄从58.4岁增加到63.4岁，男性比例稳定在70%左右。冠状动脉造影的使用率从49.8%上升到81.1%，而纤溶下降到0.4%。住院死亡率从9%降至1.5%。整体内固定（动脉时间、中心静脉导管、临时起搏器、Swan-Ganz、导管和主动脉内球囊泵）的百分比从38%下降到8.1%。从1995年到2003年，经皮冠状动脉腔内成形术中支架置入的比例从0%急剧上升到86%。在过去的五年中，外科血运重建术一直保持稳定，约占所有入院患者的20%。非冠状动脉胸痛诊断出院的患者比例保持不变，约为4%。解释：效率有了巨大的提高，三级CCU的入院流失率大约翻了一番。急性冠状动脉综合征患者分层更快，治疗更具侵入性。治疗方面的进步反映在住院死亡率每年几乎呈线性下降0.5%。
BACKGROUND: Epidemiotogical information on patients with acute coronary syndromes managed in specialized cardiac centres is limited.OBJECTIVE: To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period.METHODS: A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed. RESULTS: From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7.5 to 3.5 days. The mean age increased from 58.4 to 63.4 years, and the proportion of men remained stable at approximately 70%. The use of coronary angiograms increased from 49.8% to 81.1% in all patients, while fibrinolysis dropped to 0.4%. In-hospital mortality decreased from 9% to 1.5%. The percentage of overall instrumentation (arterial tine, central venous catheter, temporary pacemaker, Swan-Ganz, catheter and intra-aortic balloon pump) decreased from 38% to 8.1 %. From 1995 to 2003, the proportion of stenting during percutaneous transluminal coronary angioplasty increased dramatically from 0% to 86%. In the past five years, surgical revascularization has remained stable at approximately 20% of all admissions. The proportion of patients discharged with a noncoronary chest pain diagnosis has remained constant at approximately 4%.INTERPRETATION: There has been a tremendous increase in efficiency, with an approximate doubling of the admissions turnover rate in a tertiary CCU. Patients with acute coronary syndromes are stratified faster and treated more invasively. Therapeutic advances are reflected by an almost linear 0.5% per year decrease in in-hospital mortality.