Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction:: findings from the Global Registry of Acute Coronary Events (GRACE)
Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction:: findings from the Global Registry of Acute Coronary Events (GRACE)
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DOI：
10.1016/s0140-6736(02)07595-5
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发表时间：
2002-02-02
期刊：
影响因子：
168.9
通讯作者：
López-Sendón, J
中科院分区：
文献类型：
--
作者：
Eagle, KA;Goodman, SG;López-Sendón, J
背景：再灌注治疗对急性冠脉综合征患者的益处已得到证实，但在再灌注类型和患者资格的决定方面存在很大差异。本研究评估了目前的做法，在多国，前瞻性的全球急性冠脉事件登记处收集的数据，ST段抬高心肌梗死的再灌注治疗，94家医院在14个国家正在招募患者的注册，医院被组织成基于人口的集群，反映该地区的人口特征。有关患者的人口统计学特征，表现出的症状，病史，症状发作和表现之间的时间，临床和心电图特征的信息记录在一个标准的case record.Findings的9251例患者参加，1763在12小时内出现症状发作ST段抬高心肌梗死。其中，30%没有接受再灌注治疗。老年患者（75岁及以上）、无胸痛患者、有糖尿病、充血性心力衰竭、心肌梗死或冠状动脉搭桥手术史的患者接受再灌注治疗的可能性较小。美国的直接经皮冠状动脉介入治疗率最高，澳大利亚、新西兰和加拿大最低。率在网站与导管实验室为19%，与零相比，在网站没有这个facility.Interpretation一个相当大的比例的患者谁是合格的再灌注治疗仍然没有接受这种治疗。这些典型的高风险患者可以提前识别，并且需要澄清这些有益治疗未充分使用的原因。
Background The benefits of reperfusion therapy for patients with acute coronary syndromes have been established, but there is much variation in the type of reperfusion given and decisions about which patients are eligible. This study assessed current practices in relation to reperfusion therapy of ST-segment-elevation myocardial infarction from data collected in the multinational, prospective Global Registry of Acute Coronary Events.Methods 94 hospitals in 14 countries are recruiting patients for the registry, Hospitals are organised into population-based clusters that reflect the population characteristics of the region. Information about patients' demographic characteristics, presenting symptoms, medical history, time between symptom onset and presentation, and clinical and electrocardiographic features is recorded in a standard case record.Findings Of the 9251 patients enrolled, 1763 presented within 12 h of symptom onset with ST-segment-elevation myocardial infarction. Of these, 30% did not receive reperfusion therapy. Elderly patients (75 years and older), those presenting without chest pain, and those with a history of diabetes, congestive heart failure, myocardial infarction, or coronary bypass surgery were less likely to receive reperfusion therapy. The rate of primary percutaneous coronary intervention was highest in the USA and lowest in Australia, New Zealand, and Canada. The rate at sites with a catheterisation laboratory was 19% compared with zero at sites without this facility.Interpretation A substantial proportion of patients who are eligible for reperfusion therapy still do not receive this treatment. These typically high-risk patients can be identified in advance, and reasons for the underuse of these beneficial treatments need to be clarified.