Brocco Stefano, Fedeli Ugo, Schievano Elena, Milan Giovanni, Avossa Francesco, Visentin Cristiana, Alba Natalia, Olivari Zoran, Di Pede Francesco, Spolaore Paolo
SER-Epidemiological Department, Veneto Region, Italy.
J Cardiovasc Med (Hagerstown). 2006 Jan;7(1):45-50. doi: 10.2459/01.JCM.0000199787.45940.68.
To assess the burden of hospitalization for acute coronary syndrome (ACS) and the impact of the new diagnostic criteria for acute myocardial infarction on epidemiology of ACSs.
We analysed the hospital discharge record archives of the Veneto Region in the period 2000-2003, including admissions of regional residents outside the study area. We defined a list of ICD-9-CM codes for the identification of different types of ACS. We examined trends in standardized hospitalization rates as well as patient characteristics (age, sex) and pattern of care (setting, invasive revascularization, length of hospital stay, in-hospital mortality).
The hospitalization rate for non-ST-elevation myocardial infarction increased by about 70%, with a parallel decrease in hospitalizations for unstable angina, whereas the hospitalization rate for ST-elevation myocardial infarction remained unchanged. These trends are likely influenced by the new diagnostic criteria for acute myocardial infarction. At the end of the study period, although the main patient characteristics did not vary substantially, the pattern of care turned out to be more aggressive.
Despite some limitations, our results indicate that the new diagnostic criteria for acute myocardial infarction have a major impact on epidemiological evaluation. These data may be relevant when comparing epidemiological data of different periods and planning healthcare policies. Further studies are needed in order to evaluate the accuracy of ICD-9-CM codes in the diagnosis of ACSs.
评估急性冠状动脉综合征（ACS）的住院负担以及急性心肌梗死新诊断标准对ACS流行病学的影响。
我们分析了威尼托地区2000 - 2003年期间的医院出院记录档案，包括研究区域外的该地区居民入院情况。我们定义了用于识别不同类型ACS的ICD - 9 - CM编码列表。我们研究了标准化住院率的趋势以及患者特征（年龄、性别）和治疗模式（治疗地点、侵入性血运重建、住院时间、院内死亡率）。
非ST段抬高型心肌梗死的住院率增加了约70%，不稳定型心绞痛的住院率相应下降，而ST段抬高型心肌梗死的住院率保持不变。这些趋势可能受到急性心肌梗死新诊断标准的影响。在研究期结束时，尽管主要患者特征变化不大，但治疗模式变得更加积极。
尽管存在一些局限性，我们的结果表明急性心肌梗死新诊断标准对流行病学评估有重大影响。在比较不同时期的流行病学数据和制定医疗政策时，这些数据可能具有相关性。为了评估ICD - 9 - CM编码在ACS诊断中的准确性，还需要进一步研究。
