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目的:了解我国目前ST段抬高急性冠状动脉综合征(acute coronary syndrome,ACS)住院患者接受经循证医学证实有效的临床治疗的应用现状。方法:在中国31个省市自治区选择32家三级医院和32家二级医院注册研究,每家医院选择患者50例,共3 223例,对其中ST段抬高ACS的1307例患者的临床特点、接受再灌注现状、应用阿司匹林、血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitors,ACEI)或血管紧张素受体阻滞剂(an-giotensin receptor blockers,ARB)、β-受体阻滞剂、低分子量肝素、氯吡格雷和他汀类调脂药物的临床情况及预后进行评价。结果:(1)在不同地区、不同级别医院接受再灌注治疗率为30.9%～69.4%;单纯溶栓治疗率为1.9%～45.8%、经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者的治疗率为1.3%～62.7%;其中急诊PCI、补救PCI、择期PCI的治疗率分别为0～28.8%,0～9.1%,0～36.6%;溶栓治疗率二级医院显著高于三级医院(36.8%vs.14.6%,P<0.01),接受PCI的治疗率三级医院显著高于二级医院(48.2%vs.6.46%,P<0.01),总灌注率为53.8%;而有46.2%的患者未接受任何形式的再灌注治疗。(2)药物使用率分别为:阿司匹林88.0%～98.6%、ACEI或ARB 60.5%～84.4%、β-受体阻滞剂55.8%～84.4%、低分子量肝素54.2%～94.2%、氯吡格雷14.3%～88.6%、调脂药51.9%～90.9%;在不同地区、不同级别医院低分子量肝素、氯吡格雷和他汀类调脂药应用差异有统计学意义(P<0.01)。(3)住院期间主要事件的发生率以及死亡或再发心肌梗死联合事件发生率,二级医院高于三级医院(P<0.05),接受再灌注与非再灌注治疗患者有显著差异(P<0.01)。(4)多因素分析结果表明,年龄、高血压、糖尿病、再灌注治疗、使用阿司匹林、ACEI或ARB、β-受体阻滞剂与住院期间死亡率有独立的联系。结论:目前我国ST段抬高ACS的临床治疗在三级医院与二级医院之间、各地区之间存在很大的差异,仍有较大的提升空间,应加大力度推动指南在心血管临床实践中的实施。
OBJECTIVE: To understand the current status of clinical treatment of patients with ST-elevation acute coronary syndrome (ACS) admitted to China via evidence-based medicine. Methods: A total of 32 tertiary hospitals and 32 secondary hospitals were enrolled in 31 provinces in China. Fifty patients were selected in each hospital, with a total of 3 223 cases. Of the 1307 patients with ST-segment elevation ACS, The current status of reperfusion, application of aspirin, angiotensin-converting enzyme inhibitors (ACEIs) or an-giotensin receptor blockers (ARBs), β-receptor blockers Demulsifier, low molecular weight heparin, clopidogrel and statin lipid-lowering drugs clinical situation and prognosis were evaluated. Results: (1) The rates of reperfusion in different hospitals and hospitals were 30.9% ~ 69.4%, 1.9% ~ 45.8% in patients undergoing percutaneous coronary intervention (PCI) The treatment rates of emergency PCI, rescue PCI and elective PCI were 0-28.8%, 0-9.1% and 0-36.6%, respectively; the rate of thrombolytic therapy in second-grade hospital was significantly higher than that of third-grade hospital (36.8% vs.14.6%, P <0.01). The rate of PCI in tertiary hospitals was significantly higher than that of secondary hospitals (48.2% vs.6.66%, P <0.01), and the total perfusion rate was 53.8% 46.2% of patients did not receive any form of reperfusion therapy. (2) The rates of drug use were as follows: aspirin 88.0% -98.6%, ACEI or ARB 60.5% -84.4%, β-blocker 55.8% -84.4%, low molecular weight heparin 54.2% -94.2%, clopidogrel 14.3% ~ 88.6% and lipid-lowering drugs 51.9% ~ 90.9%. There were significant differences in the application of low molecular weight heparin, clopidogrel and statins in different regions and hospitals (P <0.01). (3) The incidence of major events during hospitalization and the incidence of death or recurrent myocardial infarction were higher in the second-class hospital than in the third-class hospital (P <0.05), and there was significant difference between the patients receiving reperfusion and non-reperfusion <0.01). (4) Multivariate analysis showed that age, hypertension, diabetes mellitus, reperfusion therapy, use of aspirin, ACEI or ARB, β-blockers were independently associated with in-hospital mortality. Conclusion: At present, the clinical treatment of ST-segment elevation ACS in our country has great differences among tertiary hospitals and secondary hospitals, and there is still much room for improvement. Therefore, we should step up efforts to promote the guidelines in cardiovascular clinical Practice in practice.