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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鍾國彪(Kuo-Piao Chung) | |
dc.contributor.author | Chun-Lin Chi | en |
dc.contributor.author | 紀俊麟 | zh_TW |
dc.date.accessioned | 2021-06-15T02:23:24Z | - |
dc.date.available | 2010-09-16 | |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-08-18 | |
dc.identifier.citation | REFERENCES
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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction): Developed in Collaboration With the American Academy of Family Physicians and the American College of Emergency Physicians: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine. Circulation 2008;118:2596-648. 15. Budaj A, Yusuf S, Mehta SR, et al. Benefit of clopidogrel in patients with acute coronary syndromes without ST-segment elevation in various risk groups. Circulation 2002;106:1622-6. 16. Yusuf S, Mehta SR, Zhao F, et al. Early and late effects of clopidogrel in patients with acute coronary syndromes. Circulation 2003;107:966-72. 17. Mehta SR, Yusuf S, Peters RJG, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001;358:527-33. 18. Szuk T, Gyongyosi M, Homorodi N, et al. Effect of timing of clopidogrel administration on 30-day clinical outcomes: 300-mg loading dose immediately after coronary stenting versus pretreatment 6 to 24 hours before stenting in a large unselected patient cohort. Am Heart J 2007;153:289-95. 19. Bhatt DL. Role of antiplatelet therapy across the spectrum of patients with coronary artery disease. The American journal of cardiology 2009;103:11A-9A. 20. Ho PM, Peterson ED, Wang L, et al. Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome. JAMA 2008;299:532-9. 21. Dogan A, Ozgul M, Ozaydin M, et al. Effect of clopidogrel plus aspirin on tissue perfusion and coronary flow in patients with ST-segment elevation myocardial infarction: a new reperfusion strategy.[see comment]. Am Heart J 2005;149:1037-42. 22. Fox KAA, Mehta SR, Peters R, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical Revascularization for non-ST-elevation acute coronary syndrome - The Clopidogrel in Unstable Angina to prevent Recurrent Ischemic Events (CURE) trial. Circulation 2004;110:1202-8. 23. Mehta RH, Roe MT, Mulgund J, et al. Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol 2006;48:281-6. 24. Roe MT, Parsons LS, Pollack CV, Jr., et al. Quality of care by classification of myocardial infarction: treatment patterns for ST-segment elevation vs non-ST-segment elevation myocardial infarction. Arch Intern Med 2005;165:1630-6. 25. Peterson ED, Roe MT, Mulgund J, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA 2006;295:1912-20. 26. Bradley EH, Herrin J, Elbel B, et al. Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality. JAMA 2006;296:72-8. 27. Heras M, Bueno H, Bardaji A, et al. Magnitude and consequences of undertreatment of high-risk patients with non-ST segment elevation acute coronary syndromes: insights from the DESCARTES Registry. Heart 2006;92:1571-6. 28. Dziewierz A, Siudak Z, Rakowski T, et al. More aggressive pharmacological treatment may improve clinical outcome in patients with non-ST-elevation acute coronary syndromes treated conservatively. Coron Artery Dis 2007;18:299-303. 29. Afilalo J, Piazza N, Tremblay S, Soucy N, Huynh T. Symptom-to-door time in ST segment elevation myocardial infarction: overemphasized or overlooked? Results from the AMI-McGill study. Can J Cardiol 2008;24:213-6. 30. Montalescot G, Sideris G, Meuleman C, et al. A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol 2006;48:931-8. 31. Tricoci P, Peterson ED, Roe MT. Patterns of guideline adherence and care delivery for patients with unstable angina and non-ST-segment elevation myocardial infarction (from the CRUSADE Quality Improvement Initiative). The American journal of cardiology 2006;98:30Q-5Q. 32. Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1607-21. 33. Slattery D, Pollack CV, Jr. Does timing matter? Upstream or downstream administration of antiplatelet therapy. Am J Emerg Med 2009;27:348-61. 34. Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000;284:835-42. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/43559 | - |
dc.description.abstract | 背景: Clopidogrel藥物已經是急性心肌梗塞的標準治療之一,但初始劑量的最佳給藥時間為何,仍然沒有定論。
目的: 研究Clopidogrel藥物給藥時間與急性心肌梗塞病患預後的相關性。 材料與方法: 本研究為回溯性、觀察性研究,針對2004年9月至2006年8月期間,三間醫院共254名急性心肌梗塞病患進行資料收集。排除不適用此藥物之病患後,研究人員收集病患基本資料、給藥時間、以及病患是否發生併發症之情況。病患進一步被分為早期治療組(到院時間至給藥時間間距小於四小時)以及晚期治療組(到院時間至給藥時間間距大於四小時)。 結果: 早期治療組之併發症機率明顯較晚期治療組低 (早期治療組併發症機率2.8%、晚期治療組12.6%,P=0.003)。早期治療的益處,在邏輯式迴歸分析以及分層分析之後,仍然相當顯著。晚期治療明顯與併發症有相關性,其勝算比為5.105,95%信賴區間為1.596 – 16.333,P=0.006。若將晚期治療組進一步分為兩個次群組(「4至24小時」,以及「大於24小時」),則可觀察到「預後」與「給藥時間」的漸層相關性(Chi-square for trend, P=0.002)。超過24小時才接受到藥物的病患,其併發症發生率最高。 結論: 得到Clopidogrel藥物早期治療(小於四小時)之急性心肌梗塞病患,其併發症發生率較接受晚期治療之病患明顯降低。 關鍵字: clopidogrel, 急性心肌梗塞, 給藥時間 | zh_TW |
dc.description.abstract | Background: Although clopidogrel treatment has become a standard therapy in the management of acute myocardial infarction, the optimal timing for initial clopidogrel administration is yet to be determined.
Objective: To explore the association of time of initial clopidogrel administration in the emergency department (ED) and patient outcomes. Methods: This retrospective, observational study was conducted at two university tertiary hospitals and one community hospital. Consecutive patients with acute myocardial infarction (n=254) were enrolled from September 2004 to August 2006. Patients with contraindications for clopidogrel treatment were excluded. Patient characteristics, initial treatment time, and adverse outcomes were recorded. Subjects were classified as early group (treatment initiated within 4 hours of ED arrival) and late group (treatment initiated later than 4 hours). Results: The early group demonstrated a much lower rate of adverse outcomes (2.8% vs. 12.6% in late group, P=0.003). The benefits of early administration of clopidogrel persisted after stratification and adjustment for patient and clinical factors. Late clopidogrel administration was associated with significantly increased adverse outcomes (adjusted odds ratio, 5.105, 95% confidence interval, 1.596 to 16.333, P=0.006). When the late group was further divided into two subgroups (4-24 hrs vs. > 24 hrs), a graded association was noted between time to initial clopidogrel administration and adverse outcomes (Chi-square for trend, P=0.002). Patients receiving clopidogrel >24 hours of ED presentation had the highest incidence of adverse outcomes. Conclusions: Patients who receive early clopidogrel treatment in the ED have significantly reduced adverse outcomes after acute myocardial infarction. Key words: clopidogrel, myocardial infarction, timing of administration | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T02:23:24Z (GMT). No. of bitstreams: 1 ntu-98-R95843003-1.pdf: 571510 bytes, checksum: c0df677bce7a04dab9f1a154c6973ce1 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | Contents
口試委員會審定書 誌謝 中文摘要 英文摘要 Chapter 1 Introduction 1 Study Purpose 1 Chapter 2 Literature Review 2 Clopidogrel in Patients at Risk of Ischemic Events 2 Guidelines Regarding Clopidogrel Administration in Acute Coronary Syndromes 3 Non-ST-Segment Elevation Myocardial Infarction and Unstable Angina 3 ST-Segment Elevation Myocardial Infarction 6 Clopidogrel in Patients Undergoing Coronary Artery Bypass Grafting 6 Quality of Care in Acute Coronary Syndromes 8 Summary of Literature Review 11 Chapter 3 Material and Method 12 Study design 12 Patient population 12 Data abstraction 13 Study groups 13 Adverse events 14 Statistical analysis 15 Chapter 4 Results 16 Timing of administration 16 Factors associated with timing of clopidogrel administration 17 Outcome differences between early group and late group 17 Difference in STEMI and NSTEMI 18 TIMI risk scores 18 Chapter 5 Discussion 19 Compliance rate of clopidogrel administration 19 Timeliness of clopidogrel administration and the impact on outcomes 20 Difference in treatment patterns between NSTEMI and STEMI 22 TIMI Risk Scores 22 Limitations 23 Conclusion 23 References 39 Appendix 44 Appendix 1: Recording Sheet for Acute Coronary Syndromes 44 Appendix 2: ROC curve 45 Appendix 3: IRB documentation 46 List of Tables Tables 26 Table 1. Factors associated with clinical outcomes in patients with acute myocardial infarction 26 Table 2. Patient Baseline Characteristics According to Time to Clopidogrel Administration 28 Table 3. Factors Associated with Late Clopidogrel Administration 29 Table 4. Adverse Outcomes in Clopidogrel Early vs. Late Groups Stratified by Patient and Clinical Factors 30 Table 5. Characteristics and Adverse Outcomes of Clopidogrel Administration 31 Table 6. Adjusted and Unadjusted Odds Ratios of Adverse Outcomes According to Time-to-Clopidogrel Administration 32 List of Figures Figures 33 Figure 1. The Goal of Clopidogrel Treatment 33 Figure 2. Distribution of Timing of Clopidogrel Administration 34 Figure 3. Rate of Adverse Outcomes According to Time-to-Clopidogrel Administration 35 Figure 4. Age vs. Rate of Adverse Outcomes 36 Figure 5. Distribution of TIMI Risk Scores 37 Figure 6. Rate of Adverse Outcomes in Various TIMI Risk Groups 38 | |
dc.language.iso | en | |
dc.title | 急性心肌梗塞病患預後與Clopidogrel藥物給藥時間之相關性 | zh_TW |
dc.title | Timeliness of Clopidogrel Administration for Acute Myocardial Infarction in the Emergency Department: Is Door-to-drug Time a Good Indicator of Outcome? | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 馬惠明(Matthew Huei-Ming Ma) | |
dc.contributor.oralexamcommittee | 陳文鍾(Wen-Jone Chen),石崇良(Chung-Liang Shih) | |
dc.subject.keyword | clopidogrel,急性心肌梗塞,給藥時間, | zh_TW |
dc.subject.keyword | clopidogrel,myocardial infarction,timing of administration, | en |
dc.relation.page | 46 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-08-18 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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