加拿大分析健保資料，STEMI的reperfusion時效性比方法重要!!

加拿大的健保資料…科科

The Importance of Being Timely

In a population-based cohort with ST-segment-elevation myocardial infarction, time to reperfusion had a stronger effect than method of reperfusion on outcomes.

Clinical trial and registry data show that rapid coronary reperfusion improves outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). To assess the importance of timely treatment in a broader population, investigators evaluated STEMI care from October 2006 through March 2007 at 80 hospitals where >95% of patients with acute MI in Quebec, Canada, are treated.

Of 2356 STEMI patients, 61.1% received primary percutaneous coronary intervention (PPCI), 16.6% received fibrinolysis, and 22.2% received neither intervention. At 30 days, mortality was 6.1% in fibrinolytic recipients and 5.2% in PPCI recipients. At 1 year, mortality was 7.4% in fibrinolytic recipients and 7.9% in PPCI recipients, and the rates of combined death or readmission for acute MI or heart failure were 13.5% and 13.6%, respectively. In patients who received no acute reperfusion treatment, 30-day and 1-year death rates were 18% and 29%, respectively. Both female sex and higher Thrombolysis in MI (TIMI) risk scores were significantly associated with increased 30-day mortality.

Fibrinolysis was untimely (>30 minutes after presentation) in 54% of recipients, and PPCI was untimely (>90 minutes after presentation) in 68% of recipients. In patients who received untimely treatment, all-cause mortality was significantly higher than in those whose treatment was timely, at both 30 days and 1 year; these associations remained largely unchanged after multivariate adjustment. In both PPCI and fibrinolysis recipients, the 1-year rate of readmission for heart failure was significantly lower with timely than with untimely treatment; however, rates of readmission for acute MI did not differ significantly by timeliness of treatment.

Comment: These findings confirm that reperfusion treatment delays are associated with substantial increases in mortality. All programs at the hospital, community, and national levels should be aimed at treating STEMI patients as rapidly as possible. According to this study, not only is watchful waiting unacceptable, but timely fibrinolysis might be more effective than delayed PPCI in some situations.

— Joel M. Gore, MD

Published in Journal Watch Cardiology June 23, 2010
Citation(s):

Lambert L et al. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA 2010 Jun 2; 303:2148.

* Original article (Subscription may be required)
* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7YzEzZWE0YjctMjEwMi00NDNiLWI5MjUtOWJkMDIzNjU4MzQ3&hl=zh_TW

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