目的:多种社会经济因素在ST段抬高型心肌梗死(STEMI)的治疗中起重要作用,并最终影响其临床疗效。基本社会医疗保险(BSMI)是我国医疗保障制度的重要经济因素。然而,尚未研究BSMI对STEMI患者临床结局的影响.这项研究的目的是调查BSMI是否是上海STEMI患者临床预后的预测因子。中国。
方法:在这项回顾性研究中,来自上海不同地区的681例STEMI患者分为四组:新农合(NCMS)组,城镇居民基本医疗保险计划(URBMI)组,城镇职工基本医疗保险(UEBMI)组和无保险组,主要不良事件(心脏死亡,非致命性再梗死,临床驱动靶病变血运重建/靶血管血运重建,中风,心力衰竭)被视为研究终点,以确定BSMI是否是预后因素。
结果:在平均36个月的随访中,NCMS患者的主要不良事件发生率(64;38.8%)明显高于其他组:URBMI(47;24.6%);UEBMI(28;15.6%);UNISURED(40;27.6%).同样,NCMS组的心脏死亡率也较高(19;11.5%).Kaplan-Meier生存分析显示,NCMS组的主要不良事件(p<0.001)和心脏死亡率(p=0.01)的无事件生存率显着降低。多因素Cox回归分析显示,BSMI是STEMI患者的重要预后因素。
结论:这些结果表明,在上海现行政策下,STEMI患者随访36个月时,BSMI与无主要不良事件生存率密切相关。中国。
OBJECTIVE: Several social economic factors play important roles in treatments of ST-elevation myocardial infarction (STEMI) and finally influence the clinical outcomes. The basic social medical insurance (BSMI) is an important economic factor in China\'s medical system. However, the impact of BSMI on clinical outcomes in STEMI patients has not been explored yet. The aim of this
study is to investigate whether BSMI is a predictor of clinical outcomes in the patients with STEMI in Shanghai, China.
METHODS: In this retrospective
study, 681 STEMI patients from different areas in Shanghai were classified into four groups: new rural cooperative medical scheme (NCMS) group, urban resident basic medical insurance scheme (URBMI) group, urban employee basic medical insurance scheme (UEBMI) group and UNINSURED group, major adverse events (cardiac death, nonfatal reinfarction, clinically driven target lesion revascularization/target vessel revascularization, stroke, heart failure) were regarded as
study endpoints to determine whether BSMI was a prognostic factor.
RESULTS: During a mean follow-up of 36 months, the incidence of major adverse events was significantly higher in NCMS patients (64; 38.8%) compared with the other groups: URBMI (47; 24.6%); UEBMI (28; 15.6%); UNISURED (40; 27.6%). Similarly, cardiac mortality was also higher in NCMS group (19; 11.5%). A Kaplan-Meier survival analysis revealed significantly lower event-free survival rate for major adverse events (p < 0.001) and cardiac mortality (p = 0.01) in NCMS group. Multivariate Cox regression analysis revealed that BSMI was an important prognostic factor in STEMI patients.
CONCLUSIONS: These results demonstrate that BSMI is closely associated with the major adverse events-free survival rate at 36-month follow-up in the STEMI patients under the current policies in Shanghai, China.