急性心筋梗塞における死亡率と病院前の血栓解離:メタ解析

L J Morrison¹, P R Verbeek, A C McDonald

¹Sunnybrook and Women's College Health Science Centre, 2075 Bayview Ave, Suite BG-20, Toronto, Ontario, Canada M4N 3M5. l.morrison@utoronto.ca

JAMA

|May 20, 2000

まとめ

急性心筋梗塞 (AMI) の病院前血栓解離は,死亡率と治療までの時間を大幅に削減します. このメタアナリシスは,病院内投与と比較して,その有効性を確認しています.

科学分野:

心臓病学心臓病学
緊急医療緊急医療
クリニック・トライアル臨床試験

背景:

急性心筋梗塞 (AMI) の早期血栓解離は生存率を改善することができます.
病院前対病院内血栓解剖に関する包括的なシステマティック・レビューは存在しない.

研究の目的:

AMIに対する病院前および病院内血栓解剖を比較するランダム化対照試験のメタ分析を実施する.
病院内死亡率への影響を評価する.

主な方法:

複数のデータベース (MEDLINE,EMBASEなど) で検索しました. また,関連するランダム化統制試験 (RCT) の他の情報源.
AMIに対する病院前対病院内血栓解剖を比較した6つのRCT (6434人の患者) を含む.
盲目の審査員による独立したデータ抽象化と品質評価.

主要な成果:

病院前の血栓溶解は,病院での全原因死亡率を著しく低下させた (OR,0.83;95%CI,0.70-0.98).
血栓解離までの時間は,病院前グループ (104分 vs. 162分) で著しく短かった.
結果は,異なる試験の質と提供者の経験レベルにおいて一貫していました.

結論:

AMIの病院前血栓解離は,治療までの時間が短縮され,全原因の病院での死亡率が低下する.
このアプローチは,急性心筋梗塞の患者に著しい生存効果をもたらします.

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