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首页> 外文期刊>Sao Paulo Medical Journal >Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro
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Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

机译：里约热内卢市辖区急性心肌梗塞的药理管理

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CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS) in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS) with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2). 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4). The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0). Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9) of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6); beta-blockers in 49.0% (95% CI 43.8 to 54.1); angiotensin-converting enzyme (ACE) inhibitors in 63.3% (95% CI 58.2 to 68.1); nitrates in 82.0% (95% CI 82.4 to 89.6); heparin in 81.3% (95% CI 76.9 to 85.0); calcium antagonists in 30.5% (95% CI 26.0 to 35.4). There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and intravenous nitrates). The use of calcium antagonists, not supported by scientific evidence in acute myocardial infarction, was quite frequent. A logistic model documented the benefit of aspirin, beta-blockers and ACE inhibitor use in reducing the chance of hospital death.
机译：背景：国际研究表明，急性心肌梗死的干预措施利用模式差异很大。目的：分析急性心肌梗塞药理学干预措施的使用模式及其对医院死亡率的影响。设计：横断面研究。地方：里约热内卢市辖区的巴西国家卫生系统（SUS）医院。样本：1997年在研究区中从SUS医院信息系统（SIH / SUS）注册的1,936例入院患者中选择了391份病历的分层医院样本。主要测量指标：性别，年龄，治疗时间，危险因素，严重性因素，诊断确认，使用药物干预，医院死亡，溶栓治疗的禁忌症，阿司匹林的禁忌症。结果：我们审查了98.2％的抽样医疗记录。确诊为急性心肌梗死的比例为91.7％（95％CI为88.3至94.2）。男性为61.5％，女性为38.5％，平均年龄为60.2岁（SD 2.4）。症状发作与入院之间的中位时间间隔为11小时。医院死亡率为20.6％（95％CI为16.7至25.0）。 19.5％（95％CI为15.8至23.9）的患者采用了静脉溶栓治疗;阿司匹林占86.5％（95％CI为82.5至89.6）; β受体阻滞剂占49.0％（95％CI为43.8至54.1）;血管紧张素转换酶（ACE）抑制剂占63.3％（95％CI 58.2至68.1）;硝酸盐含量为82.0％（95％CI为82.4至89.6）;肝素占81.3％（95％CI为76.9至85.0）;钙拮抗剂的比例为30.5％（95％CI为26.0至35.4）。在具有不同法律性质的医院之间，溶栓治疗，β-受体阻滞剂，ACEI，钙拮抗剂和肝素的使用存在显着差异。结论：某些干预措施（溶栓治疗，阿司匹林，β-受体阻滞剂和静脉内硝酸盐）未得到充分利用。在急性心肌梗塞中，没有科学证据支持的钙拮抗剂的使用非常频繁。 Logistic模型记录了阿司匹林，β受体阻滞剂和ACE抑制剂在减少医院死亡机会方面的益处。

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