1984年至1993年间急性心肌梗死的院内治疗趋势——哈利法克斯县莫尼卡项目

Trends in the in-hospital treatment of acute myocardial infarction between 1984 and 1993 - The Halifax County MONICA Project.

作者信息

Gregor R D, Bata I R, Brownell B, Wolf H K

机构信息

Dalhousie University, Halifax, Canada.

出版信息

Can J Cardiol. 2000 May;16(5):596-603.

PMID:10833539

Abstract

BACKGROUND

The Halifax County MONItoring of trends and determinants in CArdiovascular disease (MONICA) Project found that between 1984 and 1988, the proportion of myocardial infarctions (MIs) that were fatal within 28 days remained constant, but declined between 1989 and 1993. The objective was to investigate association among case fatality, treatment and case severity of MI in hospitalized patients.

PATIENTS AND METHODS

The MONICA MI register contains data on demographics, health history, in-hospital investigations, interventions and treatment, and vital status at 28 days after onset of symptoms for all MIs occurring in residents of Halifax County, aged 25 to 74 years. Logistic regression analysis was used to estimate trends in the use of cardioactive drugs and revascularization procedures. A case severity score was developed from patient characteristics at time of admission. Case fatality was calculated as the proportion of MIs that were fatal within 28 days.

RESULTS

Between 1984 and 1988, a large increase (OR 1.3) occurred in the use of angiotensin-converting enzyme (ACE) inhibitors, acetylsalicylic acid (ASA), thrombolysis and percutaneous transluminal coronary angioplasty (PTCA); a minor increase occurred in use of calcium channel blockers (OR=1.29, 99% CI 1.19 to 1.40); beta-blocker use decreased; case fatality remained constant and case severity score increased. From 1989 to 1993, ACE inhibitor use increased (OR=1.4, 99% CI 1.27 to 1.55); minor increases occurred in use of ASA and beta-blockers, and in PTCA and coronary artery bypass grafting; case severity did not change and case fatality decreased.

CONCLUSIONS

While use of beneficial treatment increased between 1984 and 1988, MI case fatality did not decrease, probably because case severity increased. Between 1989 and 1993, case severity remained constant, and the further increase in the use of beneficial therapy was associated with a decline in case fatality.

摘要

背景

哈利法克斯县心血管疾病趋势与决定因素监测（MONICA）项目发现，1984年至1988年期间，28天内致命性心肌梗死（MI）的比例保持不变，但在1989年至1993年期间有所下降。目的是调查住院患者中MI的病死率、治疗与病例严重程度之间的关联。

患者与方法

MONICA心肌梗死登记册包含了哈利法克斯县25至74岁居民中所有发生MI患者的人口统计学数据、健康史、住院检查、干预措施与治疗情况以及症状发作后28天的生命状态。采用逻辑回归分析来估计使用心血管活性药物和血运重建术的趋势。根据入院时的患者特征制定了病例严重程度评分。病死率计算为28天内致命性MI的比例。

结果

1984年至1988年期间，血管紧张素转换酶（ACE）抑制剂、乙酰水杨酸（ASA）、溶栓治疗和经皮腔内冠状动脉成形术（PTCA）的使用大幅增加（比值比[OR]为1.3）；钙通道阻滞剂的使用略有增加（OR = 1.29，99%可信区间[CI]为1.19至1.40）；β受体阻滞剂的使用减少；病死率保持不变，病例严重程度评分增加。1989年至1993年期间，ACE抑制剂的使用增加（OR = 1.4，99% CI为1.27至1.55）；ASA、β受体阻滞剂、PTCA和冠状动脉搭桥术的使用略有增加；病例严重程度未变，病死率下降。