Herlitz J, Karlson B W, Lindqvist J, Sjölin M
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Am Heart J. 2001 Oct;142(4):624-32. doi: 10.1067/mhj.2001.117965.
Our purpose was to describe the mortality rate and mode of death over 10 years and factors associated with death among patients admitted to the emergency department with acute chest pain or other symptoms consistent with acute myocardial infarction (AMI).
All patients who came to the emergency department at Sahlgrenska University Hospital in Göteborg, Sweden, with acute chest pain or other symptoms consistent with AMI during a 21-month period were studied.
In all, 5362 patients were registered, for whom information on 10-year mortality was available in 5158 (96.2%). In all, there were 2126 deaths (41.2%). Fifty-two percent of patients were </=65 years old. Independent predictors of death registered on admission to hospital during the subsequent 10 years were age (relative risk 1.08, 95% CI 1.07-1.09), male sex (1.38, 1.25-1.52), initial degree of suspicion of AMI (1.13, 1.06-1.19), a pathologic initial electrocardiogram (1.76, 1.56-1.98), symptoms of congestive heart failure (1.66, 1.39-1.98), "other" nonspecific symptoms (1.22, 1.07-1.39), a history of diabetes mellitus (1.65, 1.44-1.88), a history of congestive heart failure (1.42, 1.26-1.60), a history of previous myocardial infarction (1.26, 1.12-1.40), and a history of hypertension (1.14, 1.03-1.26). For all these predictors there was a strong interaction with age, thus a much more marked influence on outcome among patients </=65 years old than among patients >65 years old. When the above risk indicators were simultaneously considered, development of AMI during the first 3 days after hospital admission was still an independent predictor of death (1.63, 1.43-1.86).
For patients admitted to the emergency department with acute chest pain or other symptoms consistent with AMI, several predictors based on clinical history and clinical presentation are related to the 10-year prognosis. They are more strongly associated with outcome among patients aged </=65 years. However, whether the patients have an AMI during the subsequent days will independently influence the long-term prognosis from observations on admission.
我们的目的是描述因急性胸痛或其他与急性心肌梗死（AMI）相符的症状而入住急诊科的患者10年期间的死亡率、死亡方式以及与死亡相关的因素。
对瑞典哥德堡萨尔格伦斯卡大学医院在21个月期间因急性胸痛或其他与AMI相符的症状前来急诊科就诊的所有患者进行研究。
总共登记了5362例患者，其中5158例（96.2%）有10年死亡率的相关信息。总共有2126例死亡（41.2%）。52%的患者年龄≤65岁。入院时登记的随后10年死亡的独立预测因素包括年龄（相对风险1.08，95%可信区间1.07 - 1.09）、男性（1.38，1.25 - 1.52）、对AMI的初始怀疑程度（1.13，1.06 - 1.19）、病理性初始心电图（1.76，1.56 - 1.98）、充血性心力衰竭症状（1.66，1.39 - 1.98）、“其他”非特异性症状（1.22，1.07 - 1.39）、糖尿病病史（1.65，1.44 - 1.88）、充血性心力衰竭病史（1.42，1.26 - 1.60）、既往心肌梗死病史（1.26，1.12 - 1.40）以及高血压病史（1.14，1.03 - 1.26）。对于所有这些预测因素，与年龄存在强烈的相互作用，因此对≤65岁患者结局的影响比对>65岁患者更为显著。当同时考虑上述风险指标时，入院后前3天内发生AMI仍然是死亡的独立预测因素（1.63，1.43 - 1.86）。
对于因急性胸痛或其他与AMI相符的症状入住急诊科的患者，基于临床病史和临床表现的几个预测因素与10年预后相关。它们在≤65岁患者中与结局的关联更强。然而，根据入院时的观察，患者在随后几天是否发生AMI将独立影响长期预后。
