Goldberg Robert J, Spencer Frederick A, Yarzebski Jorge, Lessard Darleen, Gore Joel M, Alpert Joseph S, Dalen James E
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Am J Cardiol. 2004 Dec 1;94(11):1373-8. doi: 10.1016/j.amjcard.2004.07.142.
Over the past several decades, significant advances have been made in the primary and secondary prevention of coronary artery disease. However, effects of changing lifestyle and treatment practices on demographic and clinical profiles and on hospital outcomes of patients who present with acute myocardial infarction (AMI) have not been well characterized. We carried out a prospective population-based investigation of >25-year trends (1975 to 2001) in demographic and clinical characteristics, treatment practices, and hospital outcomes of patients who had been hospitalized with AMI. Residents of a metropolitan area (Worcester, Massachusetts) who had been hospitalized with validated AMI (n = 10,440) in all greater Worcester hospitals during thirteen 1-year periods between 1975 and 2001 comprised the sample of interest. Patients who had been hospitalized during the most recent study years were significantly older, were more likely to be women, and had a greater prevalence of co-morbidities. Hospitalized patients were increasingly more likely to receive effective cardiac medications and coronary interventions over the period under investigation. Multivariable-adjusted hospital survival rates improved considerably over time, whereas different trends were observed in the occurrence of several important clinical complications. The present results provide insights into the changing characteristics of patients who are hospitalized with AMI, treatment practices, and their short-term outcomes. Given the magnitude of AMI and evolving approaches to manage it, continued monitoring of these trends remains of considerable clinical and public health importance.
在过去几十年中，冠状动脉疾病的一级和二级预防取得了重大进展。然而，生活方式改变和治疗方法对急性心肌梗死（AMI）患者的人口统计学和临床特征以及医院结局的影响尚未得到充分描述。我们对1975年至2001年期间因AMI住院患者的人口统计学和临床特征、治疗方法及医院结局进行了一项基于人群的前瞻性调查，研究时间跨度超过25年。样本来自1975年至2001年期间在马萨诸塞州伍斯特市所有大伍斯特医院因确诊AMI住院的居民（n = 10440）。在最近研究年份住院的患者年龄更大，女性比例更高，合并症患病率更高。在研究期间，住院患者接受有效心脏药物和冠状动脉介入治疗的可能性越来越大。多变量调整后的医院生存率随时间有显著改善，而在几种重要临床并发症的发生率方面观察到不同趋势。本研究结果为因AMI住院患者的特征变化、治疗方法及其短期结局提供了见解。鉴于AMI的严重程度以及管理AMI的方法不断演变，持续监测这些趋势在临床和公共卫生方面仍具有相当重要的意义。
