[TCT2008]ACTION注册研究显示：D2B时间提高有限，转运时间仍有待改善
发布于:2008-10-16 16:49
ACTION注册研究显示：D2B时间提高有限，转运时间仍有待改善
ACTION Registry: D2B Times Improving Slightly, Transfer Times Remain Poor
2007年7月～2008年6月，ACTION注册研究融合了CRUSADE和NRMI两项研究数据，选取了美国44个州，344个救助中心的20,681例STEMI患者，平均年龄62岁，其中男性占70%，糖尿病患者占22%，19%有MI发作史，19%有行PCI手术史。美国北卡罗来纳州达勒姆Duke大学医学中心心血管内科的医学博士John L. Petersen认为，所有入选者在近期内都存在高危因素。
结果提示：对于转院行PCI的患者而言，D2B时间在90分钟之内的比例仅为14%，而对于非转院患者，这一比例可达到75%。其中STEMI患者D2B时间在90分钟和120分钟之内的比例，2007年7月为 26% vs. 9%，2008年6月为 36% vs. 14%，另外，48%的患者D2N治疗时间可以控制在30分钟以内。
Petersen解释说：“日益发展的医疗救治系统可能会缩短D2B时间。我们都知道提高再灌注比例是一项好的举措，并且我们也在为之而努力，但是，问题是要达到规定的时间和改善PCI手术方式。药物被广泛的应用到入院的STEMI病人，如阿司匹林，β受体阻滞剂、肝素等作为急性药物用于90%的STEMI病人，它们也普遍的用于出院的病人。但是氯吡格雷仍然未被入院病人广泛应用充分利用，此药物在STEMI患者和非STEMI患者中的应用比例仅为87%和61%。”
Petersen还向大家提供了Action注册研究中STEMI患者和非STEMI住院患者（32,377例）的数据分析，STEMI病人呈现高死亡率为5.7% vs. 4.4%，心源性休克比例为5.8% vs. 2.5%，并且非STEMI患者发生心力衰竭比例（7.2% vs. 6.2%）和红细胞注入比例（8.7% vs. 6.6%）高于STEMI患者，两组患者发生再次心梗比例相同，均为1%。
（《医心评论》编辑 马秀芹 翻译 朱婧 校对）
（来源：www.tctmd.com）
ACTION Registry: D2B Times Improving Slightly, Transfer Times Remain Poor
Key Points:
Development of STEMI referral systems may improve door-to-balloon times.
By TCT Daily Staff
A door-to-balloon time of under 90 minutes was achieved in 75% of non-transferred STEMI patients but in only 14% of transferred patients, according to July 2007-June 2008 data from the ACTION registry, which is the result of the recently merged CRUSADE and NRMI registries.
The ACTION registry tracks data from 344 sites in 44 U.S. states. The demographics of STEMI patients in this registry (n=20,681) reflect a younger age range (mean age, 62 years; 70% men; 22% diabetes; 19% prior MI; 19% prior PCI). However, these patients are at higher short-term risk, according to John L. Petersen, MD, from the division of cardiovascular medicine at Duke University Medical Center in Durham, N.C.
Registry analysis revealed a higher rate of door-to-balloon times <120 minutes among transferred STEMI patients vs. door-to-balloon times <90 minutes (26% vs. 9% in July 2007 and 36% vs. 14% in June 2008; see Figure). Further, door-to-needle times <30 minutes was achieved in 48% of all patients.
Development of STEMI referral systems may improve door-to-balloon times, Petersen said.
"We are doing a good job of getting the message out there that reperfusion therapy is a good thing, but the problem is trying to get it done in the time and manner of PCI," he said.
Medication use upon admission among STEMI patients was high; aspirin, beta blockers, and heparin were used as acute medications by more than 90% of STEMI patients. The same medications also were commonly prescribed upon discharge. However, clopidogrel remains underused upon admission, Petersen said; utilization was reported in 87% of STEMI patients vs. 61% of non-STEMI patients.
STEMI vs. non-STEMI
Petersen also presented in-hospital outcomes analysis of STEMI vs. non-STEMI patients (n=32,377) from the Action registry. STEMI patients had a higher rate of death (5.7% vs. 4.4%) and cardiogenic shock (5.8% vs. 2.5%). Non-STEMI patients had a higher rate of CHF (7.2% vs. 6.2%) and red blood cell transfusion (8.7% vs. 6.6%). STEMI and non-STEMI patients had the same re-infarction rate of 1%.
Disclosures:
Dr. Petersen reports research grants from Cordis Corporation, Edwards LifeSciences, Abbott Vascular, Schering Plough, Merck, The Medicines Company, and InfraReDx.
（source：www.tctmd.com）
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