摘要
目的：本研究利用CPACS-3研究分析目前我国县级医院未接受冠状动脉介入治疗的急性冠状动脉综合征（ACS）患者住院期间抗凝药物的应用情况,探讨在真实世界医疗环境中抗凝治疗与医疗结局之间的关系。方法：对2011-09至2014-06期间,我国15个省或自治区99家县级医院未接受介入治疗的ACS住院患者进行前瞻性注册研究。共计入选资料完整的患者12 373例,收集的资料包括患者基本情况、既往病史、病情特点、抗凝药物（包括普通肝素和低分子肝素）应用情况、严重出血事件和院内死亡等。采用多因素Logistic回归分析抗凝治疗与医疗结局（院内死亡、严重出血事件及二者的联合终点）之间的关系,并控制可能的混杂因素。结果：12 373例ACS患者中,接受抗凝治疗9 985例（抗凝治疗组）,未抗凝治疗组2 388例。抗凝治疗在急性ST段抬高型心肌梗死（STEMI）、非急性ST段抬高型心肌梗死（NSTEMI）和不稳定性心绞痛（UA）患者中的应用率分别为92.7%（4 237例/4 570例）、90.8%（1 639例/1 805例）和68.5%（4 109例/5 998例）（P〈0.01）,且存在地区和性别差异（P均〈0.01）,无年龄差异。多因素分析结果显示,抗凝治疗可降低ACS患者53%的院内死亡风险[风险比（OR）=0.47;95%可信区间（CI）：0.36~0.62]。其中,降低STEMI患者55%的院内死亡风险（OR=0.45;95%CI：0.32~0.64）,降低NSTEMI患者58%的院内死亡风险（OR=0.42;95%CI：0.24~0.75）,不降低UA患者院内死亡风险（P〉0.05）,不增加各类ACS患者严重出血事件的发生风险（P〉0.05）。结论：我国县级医院的日常医疗实践中,抗凝治疗在STEMI和NSTEMI患者中应用率较高且显著减少院内死亡;在UA患者中应用率较低,但未显著减少院内死亡;总体抗凝治疗安全性良好。
Objective： To analyze the current status of anticoagulant therapy for in-hospital patients with acute coronary syndromes （ACS） at county hospitals of China and to explore the relationship between anticoagulant therapy and clinical outcomes in real medical environment. Methods： 99 county hospitals froml5 provinces of China were selected for this prospective registry study and 12373 eligible ACS patients without interventional therapy admitted from 2011-09 to 2014-06 were enrolled. The basic condition, previous history, initial assessment, anticoagulants （unfractionated heparin/low molecular weight heparin） application, severe bleeding events and in-hospital mortality were collected in all patients. Multiple logistic regression analysis was conducted to explore the relationship between anticoagulant therapy and clinical outcomes including in-hospital mortality, severe bleedingevents and combined endpoints; meanwhile, possible confounders were adjusted. Results： A total of 9985/12373 ACS patients received anticoagulant therapy and 2388 did not. Anticoagulant therapy was conducted in 92.7% （4237/4570） patients with ST-segment elevation myocardial infarction （STEMI）, 90.8% （1639/1805） with non-ST-segment elevation myocardial infarction （NSTEMI） and 68.5% （4109/5998） with unstable angina （UA）; there were differences by regions and genders, P〈0.01and no difference by age. Multivariable analysis indicated that anticoagulant therapy decreased the risk of in-hospital mortality in ACS patients at 53% （OR= 0.47, 95% CI 0.36-0.62）, such reduction in STEMI patients was at 55% （OR=0.45, 95% CI 0.32-0.64）, in NSTEMI patients was at 58% （OR=0.42, 95% CI 0.24-0.75）; while it had no real effect in UA patients, P〉0.05. Meanwhile, it did not increase the risk of severe bleeding events in ACS patients, P〉0.05. Conclusion： Anticoagulant therapy has been widely used in STEMI and NSTEMI patients at county hospitals of China and obviously decreased the in-hospital mortality; whi
出处
《中国循环杂志》
CSCD
北大核心
2016年第6期536-540,共5页
Chinese Circulation Journal
关键词
急性冠状动脉综合征
抗凝药
院内死亡
严重出血事件
Acute coronary syndromes
Anticoagulants
In-hospital mortality
Severe bleeding events
