Abstract：
We aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries.
Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients.
There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers).
Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients.
There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers).
Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
摘要：
目的：评估指南推荐中引用的随机对照试验（RCT）的资格标准在EPICOR注册的急性心肌梗死后接受二级预防的患者的真实世界队列中的适用性。
方法：美国和欧洲急性心肌梗死指南提供的建议分为一般（适用于所有患者）和特定（适用于左心功能不全或心力衰竭患者）。选择了这些建议中引用的RCT，他们的入选标准适用于我们的18,117例患者的国际队列.
结果：有91.5%的人符合β受体阻滞剂的标准（一般为84.6%，具体建议为5.9%)，97.7%的患者符合肾素-血管紧张素系统抑制剂（ACEI/ARB）的建议（69.9%为一般，特定的27.9％）和4.1％的盐皮质激素受体拮抗剂（MRA）合格（仅特定推荐）。符合合格标准的患者在推荐治疗的处方下出院的比例为80-85%，70-75%的ACEI/ARB，MRA占29%。符合条件的患者百分比和接受药物治疗的患者百分比存在很大的地区差异(例如，北欧95%和东南亚57%的β受体阻滞剂)。
结论：在一般和具体指南建议中，大多数现实世界的急性心肌梗死患者都有资格接受二级预防治疗。出院时服用β受体阻滞剂和ACEI/ARB的比例很高。接受推荐治疗的患者比例存在很大的地区差异。需要有针对性的地方干预措施来提高质量。
方法：美国和欧洲急性心肌梗死指南提供的建议分为一般（适用于所有患者）和特定（适用于左心功能不全或心力衰竭患者）。选择了这些建议中引用的RCT，他们的入选标准适用于我们的18,117例患者的国际队列.
结果：有91.5%的人符合β受体阻滞剂的标准（一般为84.6%，具体建议为5.9%)，97.7%的患者符合肾素-血管紧张素系统抑制剂（ACEI/ARB）的建议（69.9%为一般，特定的27.9％）和4.1％的盐皮质激素受体拮抗剂（MRA）合格（仅特定推荐）。符合合格标准的患者在推荐治疗的处方下出院的比例为80-85%，70-75%的ACEI/ARB，MRA占29%。符合条件的患者百分比和接受药物治疗的患者百分比存在很大的地区差异(例如，北欧95%和东南亚57%的β受体阻滞剂)。
结论：在一般和具体指南建议中，大多数现实世界的急性心肌梗死患者都有资格接受二级预防治疗。出院时服用β受体阻滞剂和ACEI/ARB的比例很高。接受推荐治疗的患者比例存在很大的地区差异。需要有针对性的地方干预措施来提高质量。
