居住在农村地区st段抬高型心肌梗死患者的初始纤溶与初次经皮冠状动脉介入治疗相关的住院结果

IF 0.8 Q4 PHARMACOLOGY & PHARMACY Hospital Pharmacy Pub Date : 2024-11-29 DOI:10.1177/00185787241303485
Whitney B Sussman, Conner E Johnson, Erin R Weeda
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引用次数: 0

摘要

背景:相对于城市地区,纤溶更常用于治疗st段抬高型心肌梗死(STEMI)。然而,对这种治疗策略在农村个体中的相关结果知之甚少。我们试图比较居住在农村地区的STEMI患者与使用纤维蛋白溶解术和初次经皮冠状动脉介入治疗(PCI)相关的住院结果。方法:我们使用美国国家住院患者样本确定2016年至2021年间的STEMI成年患者。该队列仅限于居住在农村地区的个人。患者根据接受初始纤溶治疗和首次PCI治疗分为2组。在队列之间比较住院结局,住院死亡率作为主要结局,住院时间(LOS)作为次要结局。结果:我们确定了13475例农村STEMI患者接受了初始纤溶治疗(n = 1095)或首次PCI治疗(n = 12380)。队列之间的平均年龄和合并症数量相似。住院死亡率为5.2%,初始纤溶患者和初次PCI患者的平均生存时间分别为3.73±3.739天和3.45±3.974天。调整协变量后,初始纤溶与较高的住院死亡率无关(优势比[OR] = 0.913;95%可信区间[CI] = 0.679-1.228)。与初次PCI相比,初始纤溶与LOS的小幅增加相关(平均差异= 0.079天;95%ci = 0.035-0.123)。结论:在这项分析中,在农村个体中约有13000例STEMI病例,初始纤溶治疗与初次PCI治疗的患者特征相似。观察到的结果在队列之间没有显著差异。纤溶治疗不应被忽视的治疗策略,在农村STEMI患者面临延迟接受初级PCI。
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In-Hospital Outcomes Associated With Initial Fibrinolysis Versus Primary Percutaneous Coronary Intervention Among Patients Residing in Rural Areas Presenting With ST-Segment Elevation Myocardial Infarction.

Background: Fibrinolysis is more commonly used to manage ST-segment elevation myocardial infarction (STEMI) in rural versus urban areas. However, little is known about the outcomes associated with this treatment strategy in rural individuals. We sought to compare in-hospital outcomes associated with the use of fibrinolysis versus primary percutaneous coronary intervention (PCI) among patients residing in rural areas presenting with STEMI. Methods: We identified adult patients with STEMI between 2016 and 2021 using the United States National Inpatient Sample. The cohort was restricted to individuals residing in rural areas. Patients were divided into 2 cohorts based on the receipt of initial fibrinolysis versus primary PCI. In-hospital outcomes were compared between cohorts, with in-hospital mortality serving as the primary outcome and length of stay (LOS) serving as a secondary outcome. Results: We identified 13 475 rural STEMI encounters receiving either initial fibrinolytic therapy (n = 1095) or primary PCI (n = 12 380). The average age and number of comorbidities were similar between cohorts. In-hospital mortality occurred in 5.2% of patients, and mean LOS for initial fibrinolysis and primary PCI patients was 3.73 ± 3.739 days and 3.45 ± 3.974 days, respectively. After adjusting for covariates, initial fibrinolysis was not associated with higher in-hospital mortality (odds ratio [OR] = 0.913; 95% confidence interval [CI] = 0.679-1.228). Initial fibrinolysis was associated with a small increase in LOS compared to primary PCI (Mean difference = 0.079 days; 95%CI = 0.035-0.123). Conclusions: In this analysis of approximately 13 000 STEMI encounters among rural individuals, patient characteristics between those treated with initial fibrinolysis versus primary PCI were similar. Observed outcomes were not meaningfully different between cohorts. Fibrinolytic therapy should not be an overlooked treatment strategy in rural STEMI patients facing delays in receipt of primary PCI.

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来源期刊
Hospital Pharmacy
Hospital Pharmacy PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
0.00%
发文量
63
期刊介绍: Hospital Pharmacy is a monthly peer-reviewed journal that is read by pharmacists and other providers practicing in the inpatient and outpatient setting within hospitals, long-term care facilities, home care, and other health-system settings The Hospital Pharmacy Assistant Editor, Michael R. Cohen, RPh, MS, DSc, FASHP, is author of a Medication Error Report Analysis and founder of The Institute for Safe Medication Practices (ISMP), a nonprofit organization that provides education about adverse drug events and their prevention.
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