Furman M I, Dauerman H L, Goldberg R J, Yarzebski J, Lessard D, Gore J M
Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
J Am Coll Cardiol. 2001 May;37(6):1571-80. doi: 10.1016/s0735-1097(01)01203-7.
The goal of this study was to examine long-term trends in the incidence, in-hospital and long-term mortality patterns in patients with an initial non-Q-wave myocardial infarction (NQWMI) as compared with those with an initial Q-wave myocardial infarction (QWMI).
Limited data are available describing trends in the incidence and mortality from an initial QWMI and NQWMI from a multi-hospital community-wide perspective.
Our study was an observational study of 5,832 metropolitan Worcester, Massachusetts residents (1990 census = 437,000) hospitalized with validated initial acute MI in all greater Worcester hospitals during 11 annual periods between 1975 and 1997.
The incidence of QWMI progressively decreased between 1975/78 (incidence rate = 171/100,000 population) and 1997 (101/100,000 population). In contrast, the incidence of NQWMI progressively increased between 1975/78 (62/100,000 population) and 1997 (131/100,000 population). Hospital death rates were 19.5% for patients with QWMI and 12.5% for those with NQWMI. After controlling for various covariates, patients with QWMI remained at significantly increased risk for hospital mortality (adjusted odds ratio = 1.63; 95% confidence interval: 1.35, 1.97). While the hospital mortality of QWMI has progressively declined over time (1975/78 = 24%; 1997 = 14%), the in-hospital mortality for NQWMI has remained the same (1975/78 = 12%; 1997 = 12%). These trends remained after adjusting for potentially confounding prognostic factors. The multivariable adjusted two-year mortality after hospital discharge declined over time for patients with QWMI and NQWMI.
Despite impressive declines in the incidence, in-hospital and long-term mortality associated with QWMI, NQWMI is increasing in frequency and has the same in-hospital mortality now as it did 22 years ago.
本研究的目的是比较初始非Q波心肌梗死（NQWMI）患者与初始Q波心肌梗死（QWMI）患者在发病率、住院期间及长期死亡率模式方面的长期趋势。
从多医院社区范围的角度描述初始QWMI和NQWMI的发病率及死亡率趋势的数据有限。
我们的研究是一项对马萨诸塞州伍斯特市5832名居民（1990年人口普查为437,000人）进行的观察性研究，这些居民在1975年至1997年的11个年度期间，因确诊的初始急性心肌梗死在伍斯特市所有大医院住院。
QWMI的发病率在1975/78年（发病率=171/100,000人口）至1997年（101/100,000人口）期间逐渐下降。相比之下，NQWMI的发病率在1975/78年（62/100,000人口）至1997年（131/100,000人口）期间逐渐上升。QWMI患者的医院死亡率为19.5%，NQWMI患者为12.5%。在控制了各种协变量后，QWMI患者的医院死亡风险仍然显著增加（调整后的优势比=1.63；95%置信区间：1.35, 1.97）。虽然QWMI的医院死亡率随时间逐渐下降（1975/78年=24%；1997年= 14%），但NQWMI的住院死亡率保持不变（1975/78年=12%；1997年=12%）。在调整了潜在的混杂预后因素后这些趋势依然存在。QWMI和NQWMI患者出院后的多变量调整两年死亡率随时间下降。
尽管与QWMI相关的发病率、住院期间及长期死亡率显著下降，但NQWMI的发病率正在上升，且其目前的住院死亡率与22年前相同。
