Use of the invasive management strategy for patients with non-Q-wave myocardial infarction: an observational database report from the Worcester Heart Attack Study.
Use of the invasive management strategy for patients with non-Q-wave myocardial infarction: an observational database report from the Worcester Heart Attack Study.
复制标题
对非 Q 波心肌梗死患者使用侵入性管理策略：伍斯特心脏病研究的观察数据库报告。
DOI：
10.1067/mhj.2002.122517
复制
发表时间：
2002
影响因子：
4.8
通讯作者：
Goldberg,RobertJ
中科院分区：
文献类型：
--
作者：
Dauerman,HaroldL;Yarzebski,Jorge;Gore,JoelM;Lessard,Darleen;Goldberg,RobertJ
背景：最近的随机临床试验表明，急性冠状动脉综合征患者的侵入性管理策略是有益的。然而，除了在随机临床试验中研究的相对狭窄的患者人群外，还没有确定侵入性管理方法在急性冠状动脉综合征患者中的更广泛使用和影响。方法1990年至1997年5年间，马萨诸塞州伍斯特市所有地区医院因非Q波急性心肌梗死（AMI）住院的居民（n = 2436）。我们研究了非Q波AMI患者在医院管理中使用侵入性与保守性策略的程度、临床并发症的发生率和住院死亡率。结果只有30%的非Q波AMI患者采用侵入性方法进行医院管理，尽管随着时间的推移，侵入性治疗策略的使用有所增加（1990年为18%，1997年为33%）。与使用侵入性策略相关的因素是年轻、男性、心源性休克的发展以及持续的药物治疗。总住院死亡率高达12%。在logistic回归模型中，使用侵入性方法、阿司匹林、硝酸盐和β受体阻滞剂与生存率显著改善相关。结论在20世纪90年代，在这个以人群为基础的队列中，非Q波AMI的医院管理很少使用侵入性方法。(Am Heart J 2002;143：1033-9.）
Background Recent randomized clinical trials have suggested a benefit of an invasive management strategy in patients with acute coronary syndromes. However, the broader use and impact of the invasive management approach has not been established for patients with acute coronary syndromes beyond the relatively narrow patient populations studied in randomized, clinical trials. Methods Residents of the Worcester, Mass, area who were hospitalized with non-Q-wave acute myocardial infarction (AMI) at all area hospitals in 5 annual periods between 1990 and 1997 comprised the sample of interest (n = 2436). We examined the extent of use of an invasive versus a conservative strategy for hospital management, occurrence of clinical complications, and hospital mortality in patients with non-Q-wave AMI. Results An invasive approach to hospital management was used in only 30% of patients with non-Q-wave AMI, although there was an increase over time in the use of an invasive treatment strategy (18% in 1990 vs 33% in 1997). Factors associated with use of the invasive strategy were younger age, male sex, development of cardiogenic shock, as well as adjunctive medical treatment. Overall hospital mortality was high at 12%. Use of the invasive approach, aspirin, nitrates and β-blockers were associated in logistic regression modeling with significant improvements in survival. Conclusions An invasive approach to hospital management of non-Q-wave AMI was used infrequently in this population-based cohort during the 1990s. (Am Heart J 2002;143:1033-9.)