2006 和2011 年中国东部农村急性心肌梗死患者 早期氯吡格雷的应用研究

Early Clopidogrel therapy among patients with acute myocardial infarction in eastern rural China in 2006 and 2011

摘要:

目的 评价2006 和2011 年中国东部农村地区急性心肌梗死（AMI）患者住院早期氯吡格雷的 使用情况及影响因素。方法 通过随机抽样获取2006、2011 年东部农村具有代表性的AMI 住院患者研究数 据。评估住院早期（入院24 h 内）氯吡格雷的使用率及变化趋势，并采用多水平Logistic 回归模型分析与住 院早期氯吡格雷使用相关的影响因素。结果 32 家东部农村地区医院参加研究，筛选出2 335 例AMI 住院患者。 患者年龄25 ～ 96 岁，平均（66.7±12.2）岁，女性占33.1%。2006 ～ 2011 年AMI 患者住院早期氯吡格雷使 用率从32.0% 增加到69.0%（P <0.05）。多因素分析结果显示，合并血脂异常和高血压患者[Ol ^ R=2.30（95%CI： 1.03，5.14）和Ol ^ R=1.44（95%CI：1.14，1.81）]，以及既往行经皮冠状动脉介入治疗（PCI）患者[Ol ^ R=3.44（95%CI： 1.65，7.16）] 更易接受早期氯吡格雷。此外，入院有胸部不适的患者[Ol ^ R=2.21（95%CI ：1.53，3.18）] 和院 内接受直接PCI 患者[Ol ^ R=3.82（95%CI ：1.39，10.46）] 也倾向于使用早期氯吡格雷。相反，女性患者住院 早期氯吡格雷应用率低于男性患者[Ol ^ R=0.67（95%CI ：0.52，0.87）]。结论 2006 ～ 2011 年我国东部农村 AMI 患者住院早期氯吡格雷使用率有提高，但仍有较大的提升空间。仍需采取适当的医疗质量改善措施，促 进AMI 患者住院早期氯吡格雷的应用，改善患者生存质量。

Abstract:

Objective To describe the early use of Clopidogrel therapy in patients with acute myocardial infarction (AMI) in eastern rural China in 2006 and 2011, and to identify the factors associated with the early use of Clopidogrel therapy. Methods Based on China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, clinical information of a representative sample of hospitalized patients with AMI in eastern rural China in 2006 and 2011 were collected through a two-stage randomization sampling. Early Clopidogrel therapy was defined as initiation within 24 hours after admission. Logistic regression analysis was used to identify the factors related to the early use of Clopidogrel therapy. Results A total of 2,335 eligible patients were identified for early Clopidogrel therapy from 32 hospitals in eastern rural China, their age was 25 to 96 years with the mean age of (66.7 ± 12.2) years and 33.1% were female. From 2006 to 2011, the rate of early Clopidogrel use increased from 32.0% to 69.0% (P < 0.05). In logistic regression analysis, the patients with dyslipidemia, hypertension or the history of percutaneous coronary intervention (PCI) were more likely to receive early Clopidogrel [Ol^R=2.30 (95% CI: 1.03, 5.14), Ol^R = 1.44 (95% CI: 1.14, 1.81), Ol^R = 3.44 (95% CI: 1.65, 7.16), respectively]. Moreover, the patients with chest discomfort at admission were more likely to be treated with Clopidogrel [Oll^^R = 2.21 (95% CI: 1.53, 3.18)], and the patients receiving direct PCI during hospitalization were more likely to receive early Clopidogrel treatment [Ol^R = 3.82 (95% CI: 1.39, 10.46)]. However, the female patients were less likely to receive early Clopidogrel therapy compared with the male patients [Ol^R = 0.67 (95% CI: 0.52, 0.87)]. Conclusions From 2006 to 2011, the utilization rate of early Clopidogrel therapy increased substantially among the patients with AMI in eastern rural China. However, there is still a lot of room for improvement. Quality improvement initiatives are needed for further improvements in early Clopidogrel therapy for the patients with AMI.