中国急性ST段抬高型心肌梗死患者院前应用硝酸甘油或中成药对症状改善及梗死相关动脉血流影响的比较研究
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
赵广玉 1王朵儿 2杨进刚 1鲁晔 1陶水英 1程晓曙 3叶君明 4贺春晖 1吴超 1许海燕 1乔树宾 1赵延延 2王杨 2李卫 2高晓津 1杨跃进 1代表中国急性心肌梗死注册研究组
作者信息
- 1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 冠心病中心,北京 100037
- 2. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 医学统计部,北京 102308
- 3. 南昌大学第二附属医院 心血管内科,南昌 330006
- 4. 萍乡市人民医院 心血管内科,萍乡 337055
- 折叠
摘要
目的:比较中国急性ST段抬高型心肌梗死(STEMI)患者院前应用硝酸甘油或中成药对症状改善及对梗死相关动脉(IRA)血流的影响.方法:依托中国急性心肌梗死注册研究于 2013 年 1 月 1 日至 2014 年 3 月 31 日期间,纳入全国 108 家医院 7 d内发病且明确报告院前使用或不使用硝酸甘油或中成药的 13 064 例STEMI患者(已排除共用两类药物患者),其中5 280 例患者接受了急诊冠状动脉造影.对比使用两类药物对患者症状缓解及IRA的TIMI血流分级水平的影响,其中症状缓解包括完全缓解(症状消失)和部分缓解(不同程度缓解).结果:13 064例患者中,2 892例(22.1%)院前应用了硝酸甘油或中成药,其中1 149例(8.8%)使用了硝酸甘油,1 743例(13.3%)使用了中成药,10 172例院前未用药.应用硝酸甘油或中成药的患者,6 h内到达医院的比例(57.4%vs.60.8%vs.50.3%,P<0.0010),与使用院前急救系统的比例(11.8%vs.12.2%vs.9.5%,P=0.0004)均高于未用药的患者.使用硝酸甘油的患者部分缓解比例高于使用中成药的患者(33.8%vs.25.1%,P<0.0010).多因素Logistic分析显示,使用硝酸甘油较使用中成药完全和部分缓解的可能性较高(OR=1.331,95%CI:1.129～1.569,P=0.0007).使用硝酸甘油或中成药的患者与未用药患者的院内死亡率相似.在接受急诊冠状动脉造影的患者中,使用中成药或硝酸甘油及未用药患者IRA的TIMI血流达到2～3级的比例分别为21.6%、15.8%和19.3%(P=0.0405).多因素Logistic回归分析显示,与未用药患者相比,使用中成药患者的TIMI血流达到2～3级水平无明显优势(OR=0.856,95%CI:0.705～1.040,P=0.1171),使用硝酸甘油的患者TIMI血流达到2～3级水平可能性降低(OR=0.666,95%CI:0.495～0.895,P=0.0071).结论:中国约有 22.1%的STEMI患者院前单用硝酸甘油或中成药,含服硝酸甘油对症状改善作用优于中成药,与未用药患者相比,应用这两类药物的患者的TIMI血流未见明显改善.
Abstract
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.
关键词
急性ST段抬高型心肌梗死/硝酸甘油/中成药/症状改善/TIMI血流Key words
ST-segment elevation myocardial infarction/nitroglycerin/Chinese traditional medicine/symptom improvement/TIMI blood flow引用本文复制引用
基金项目
国家科技支撑计划(十二五)(2011BAI11B02)
中国医科院医学与健康科技创新工程项目(2020-I2M-C&T-B-050)
出版年
2024
NETL
NSTL
维普
万方数据