Comparison of Prehospital Nitroglycerin or Traditional Chinese Medicine Use on Symptom Improvement and TIMI Flow in Infarction-related Artery Among Patients With ST-segment Elevation Myocardial Infarction
Objectives:To compare the impact of prehospital utilization of nitroglycerin or Chinese traditional medicine(TCM)on symptom improvement and TIMI blood flow in infarct-related arteries(IRA)among patients with ST-segment elevation myocardial infarction(STEMI)in China.Methods:Data from Chinese Acute Myocardial Infarction Registration Study were screened.From January 1,2013 to March 31,2014,13 064 STEMI patients who developed symptoms within 7 days in 108 hospitals across the country and explicitly reported using or not using nitroglycerin or TCM before hospital(excluding those sharing two types of drugs)were included in this study.The effects of the two classes of drugs on symptom remission(symptoms disappeared)and partial remission(symptoms alleviated to varying degrees)were compared with the TIMI blood grading level of the IRA.Results:Among the 13 064 patients,a total of 2 892 patients(22.1%)used prehospital nitroglycerin or TCM,among which 1 149 patients(8.8%)used nitroglycerin,1 743 patients(13.3%)used TCM,10 172 cases did not take medication before hospital.Patients who received nitroglycerin and TCM had a higher proportion of hospital arrival within 6 hours and utilization of emergency medical systems(57.4%vs.60.8%vs.50.3%,P<0.0010).The proportion of patients with prehospital emergency care system(11.8%vs.12.2%vs.9.5%,P=0.0004)was higher than that of patients without medication.The proportion of partial symptom relief in patients with nitroglycerin was significantly higher than in the TCM group(33.8%vs.25.1%,P<0.0010).Multivariate logistic analysis showed that compared to patients treated with TCM,patients treated with nitroglycerin had a higher odds of complete and partial symptom relief(OR=1.331,95%CI:1.129-1.569,P=0.0007).Rates of in-hospital mortality and other adverse events were similar among patients who used prehospital nitroglycerin,TCM,and those who did not use any medication.Among patients who underwent emergency coronary angiography(CAG),the proportion of IRA TIMI blood flow reaching grade 2-3 were 21.6%in the TCM,15.8%in the nitroglycerin group,and 19.3%in the non-medication group(P=0.0405).Multivariate logistic regression analysis showed that compared to the non-medication group,there was no significant difference in the odds of IRA TIMI blood flow reaching the level of 2-3 in the TCM group(OR=0.856,95%CI:0.705-1.040,P=0.1171).However,the odds of patients achieving TIMI blood flow grade Ⅱ-Ⅲ was lower in the nitroglycerin group(OR=0.666,95%CI:0.495-0.895,P=0.0071).Conclusions:About 22.1%of STEMI patients in China used nitroglycerin or TCM before hospitalization,and nitroglycerin showed better symptom improvement than TCM.However,compared to patients who did not use prehospital medication,the use of these two types of drugs was not related to significant improvement in TIMI blood flow.
ST-segment elevation myocardial infarctionnitroglycerinChinese traditional medicinesymptom improvementTIMI blood flow
NETL
NSTL
万方数据
维普
