2006年、2011年中国急性ST段抬高型心肌梗死行经皮冠状动脉介入治疗患者负荷剂量氯吡格雷的应用及影响因素

摘要

Objective: To explore the application and affecting factors of clopidogrel loading therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) in china in 2006 and 2011. Methods: Based on “China patient-centered evaluative assessment of cardiac events retrospective study of acute myocardial infarction”, we collected clinical information of STEMI patients with PCI in 2006, 2011 and analyzed clopidogrel loading therapy status in different years and different hospitals. According to clopidogrel doses, the patients were divided into 2 groups: Clopidogrel 300mg group, the patients received a single dose of clopidogrel ≥300mg while <450mg and Clopidogrel 600mg group, the patients received a single dose of clopidogrel ≥450mg while ≤600mg. The relevant factors affecting clopidogrel loading therapy status were identiifed by binary Logistic regression analysis. Results: A total of 2481 eligible patients were enrolled and their mean age was (60.9 ± 12.0) years including 21.4%female. From 2006 to 2011, the overall application of clopidogrel loading was (51.0% vs 47.4%), the ratio for patients in Clopidogrel 300mg group was (43.1% vs 39.2%), in Clopidogrel 600mg group was (7.8% vs 8.2%), allP>0.05. In 2006, the hospital median rate of clopidogerl application was 44.4% (IQR 21.8% to 69.0%) and in 2011, it was 48.1% (IQR 25.0% to 70.8%),P=0.940. Binary logistic regression analysis showed that the patients were admitted within 12 hours of onset, with primary PCI and treated in central region had the higher rates of clopidogrel loading therapy. Conclusion: Clopidogrel loading therapy was seriously inadequate in STEMI patients with PCI, variation was across hospitals and the status was similar between 2006 and 2011. Clopidogrel loading therapy should be improved.%目的：了解中国急性ST段抬高型心肌梗死（STEMI）行经皮冠状动脉介入治疗（PCI）患者负荷剂量氯吡格雷的应用情况，并探讨其影响因素。方法：基于“冠心病医疗结果评价和临床转化研究—回顾性急性心肌梗死研究”，收集2006年和2011年因STEMI住院并接受PCI治疗患者的临床信息，计算不同年份患者水平和医院水平负荷剂量氯吡格雷（将单次使用剂量≥300 mg且＜450 mg者纳入300 mg组，将≥450 mg且≤600 mg者纳入600 mg组）的应用情况，并采用二元Logistic回归方法分析其使用的影响因素。结果：共入选2481例患者，平均年龄（60.9±12.0）岁，女性占21.4%。2006年至2011年，使用负荷剂量氯吡格雷总体（51.0%比47.4%）、300 mg负荷剂量（43.1%比39.2%）和600 mg负荷剂量（7.8%比8.2%）的患者比例均无明显改变（P均>0.05）。2006年，医院水平的中位使用率为44.4%[四分位间距（IQR）：21.8%至69.0%]，2011年，中位使用率为48.1%（IQR：25.0%至70.8%），两年份的中位使用率差异无统计学意义（P=0.940）。多因素分析显示，发病至入院时间小于12 h、行直接PCI和在中部地区就诊的患者负荷剂量使用率较高。结论：中国接受PCI治疗的STEMI患者中负荷剂量氯吡格雷应用严重不足，医院间差异明显且2011年较2006年未见改善。负荷剂量氯吡格雷在此类患者中的应用亟待改善。