美国德克萨斯大学医学院Peter Cram团队研究了六个国家急性心肌梗死住院患者血运重建使用和预后的差异。2022年5月4日，《英国医学杂志》发表了这一成果。

为了在六个医疗服务体系截然不同的国家中，比较初次诊断为ST段抬高或非ST段抬高心肌梗死（STEMI或NSTEMI）住院患者的治疗和预后，研究组对来自美国、加拿大、英国、荷兰、以色列和中国的患者水平管理数据进行了一项回顾性横断面队列研究。

2011年1月1日至2017年12月31日，研究组招募66岁及以上、因STEMI或NSTEMI入院的成年患者。三类结局分别是冠状动脉血运重建（经皮冠状动脉介入治疗或冠状动脉旁路移植术）、死亡率和有效率（住院时间和30天再入院）。

根据2017年美国急性心肌梗死人群的年龄和性别分布将发病率标准化。分别评估STEMI和NSTEMI的预后。对临床表现进行纵向（随时间推移）和横向（不同国家间）评估。

住院总人数从以色列的19043人到美国的1064099人不等。各国之间的所有结局都存在很大差异。例如，2017年间因STEMI入院接受经皮冠状动脉介入治疗的患者比例从36.9%（英国）到78.6%（加拿大）和71.8%（美国）不等；2011至2017年间，所有国家对ST段抬高型心肌梗死的经皮冠状动脉介入治疗使用率都有所增加，其中以色列（48.4-65.9%）和中国（49.4-70.2%）的使用率上升尤为显著。

2017年，在入院后90天内接受冠状动脉旁路移植手术的NSTEMI患者比例荷兰最低（3.5%），美国最高（11.7%）。2017年，STEMI患者入院后一年内的死亡率从18.9%（荷兰）到27.8%（美国）和32.3%（中国）不等。2017年，荷兰（5.0天）和美国（5.1天）STEMI患者的平均住院时间最短，中国（8.5天）最长；中国（11.7%）和美国（12.2%）STEMI的30天再入院率最低，英国（23.1%）最高。

综上，对六个国家的心肌梗死进行分析表明，所有国家都有表现较好的领域，但没有一个国家在这三个领域均表现出色。各国可通过对患者水平的全国代表性数据进行国际比较来相互学习。

附：英文原文

Title: Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries: cross sectional cohort study

Author: Peter Cram, Laura A Hatfield, Pieter Bakx, Amitava Banerjee, Christina Fu, Michal Gordon, Renaud Heine, Nicole Huang, Dennis Ko, Lisa M Lix, Victor Novack, Laura Pasea, Feng Qiu, Therese A Stukel, Carin Uyl de Groot, Lin Yan, Bruce Landon

Issue&Volume: 2022/05/04

Abstract:

Objectives To compare treatment and outcomes for patients admitted to hospital with a primary diagnosis of ST elevation or non-ST elevation myocardial infarction (STEMI or NSTEMI) in six high income countries with very different healthcare delivery systems.

Design Retrospective cross sectional cohort study.

Setting Patient level administrative data from the United States, Canada (Ontario and Manitoba), England, the Netherlands, Israel, and Taiwan.

Participants Adults aged 66 years and older admitted to hospital with STEMI or NSTEMI between 1 January 2011 and 31 December 2017.

Outcomes measures The three categories of outcomes were coronary revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery), mortality, and efficiency (hospital length of stay and 30 day readmission). Rates were standardised to the age and sex distribution of the US acute myocardial infarction population in 2017. Outcomes were assessed separately for STEMI and NSTEMI. Performance was evaluated longitudinally (over time) and cross sectionally (between countries).

Results The total number of hospital admissions ranged from 19043 in Israel to 1064099 in the US. Large differences were found between countries for all outcomes. For example, the proportion of patients admitted to hospital with STEMI who received percutaneous coronary intervention in hospital during 2017 ranged from 36.9% (England) to 78.6% (Canada; 71.8% in the US); use of percutaneous coronary intervention for STEMI increased in all countries between 2011 and 2017, with particularly large rises in Israel (48.4-65.9%) and Taiwan (49.4-70.2%). The proportion of patients with NSTEMI who underwent coronary artery bypass graft surgery within 90 days of admission during 2017 was lowest in the Netherlands (3.5%) and highest in the US (11.7%). Death within one year of admission for STEMI in 2017 ranged from 18.9% (Netherlands) to 27.8% (US) and 32.3% (Taiwan). Mean hospital length of stay in 2017 for STEMI was lowest in the Netherlands and the US (5.0 and 5.1 days) and highest in Taiwan (8.5 days); 30 day readmission for STEMI was lowest in Taiwan (11.7%) and the US (12.2%) and highest in England (23.1%).

Conclusions In an analysis of myocardial infarction in six high income countries, all countries had areas of high performance, but no country excelled in all three domains. Our findings suggest that countries could learn from each other by using international comparisons of patient level nationally representative data.

DOI: 10.1136/bmj-2021-069164

Source: https://www.bmj.com/content/377/bmj-2021-069164