Maynard Charles, Lowy Elliott, Rumsfeld John, Sales Ann E, Sun Haili, Kopjar Branko, Fleming Barbara, Jesse Robert L, Rusch Roxane, Fihn Stephan D
Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA 98101, USA.
Arch Intern Med. 2006 Jul 10;166(13):1410-6. doi: 10.1001/archinte.166.13.1410.
Most studies of the epidemiology and treatment of acute myocardial infarction (AMI) have focused on patients who experienced onset of their symptoms in the community and then presented to the hospital. There are, however, patients whose symptoms of AMI begin after hospitalization for other medical conditions. The purposes of this study were to determine the prevalence of in-hospital AMI in the Veterans Health Administration (VHA) and to compare baseline characteristics, treatments, and outcomes according to whether individuals presented with AMI or had an in-hospital AMI.
This was a retrospective cohort study of 7054 veterans who were hospitalized for AMI in 127 VHA medical centers between July 2003 and August 2004. The main outcome measure was 30-day mortality. Key covariates included age, body mass index, admission systolic blood pressure, heart rate, previous use of lipid-lowering drugs, elevated admission troponin value, prolonged and/or atypical chest pain on admission, and ST-segment elevation on the initial electrocardiogram.
There were 792 patients (11.2%) who had AMI while hospitalized for other medical conditions. These patients differed substantially from those who presented to the hospital with AMI. The odds of 30-day mortality were greater in the in-hospital group (odds ratio, 3.6; 95% confidence interval, 3.1-4.3; P<.001) and remained higher after statistical adjustment (odds ratio, 2.0; 95% confidence interval, 1.7-2.4; P<.001).
Although most attention has been paid to patients with AMI admitted via the community emergency medical system or through the emergency department, AMI occurring during hospitalization for other medical problems is an important clinical problem.
大多数关于急性心肌梗死（AMI）流行病学和治疗的研究都集中在那些在社区出现症状后前往医院就诊的患者身上。然而，有一些患者的AMI症状是在因其他医疗状况住院后才开始的。本研究的目的是确定退伍军人健康管理局（VHA）中院内AMI的患病率，并根据个体是表现为AMI还是院内发生AMI来比较基线特征、治疗方法和结局。
这是一项回顾性队列研究，研究对象为2003年7月至2004年8月期间在127个VHA医疗中心因AMI住院的7054名退伍军人。主要结局指标是30天死亡率。关键协变量包括年龄、体重指数、入院时收缩压、心率、既往使用降脂药物情况、入院时肌钙蛋白值升高、入院时胸痛持续时间延长和/或不典型胸痛以及初始心电图上的ST段抬高。
有792名患者（11.2%）在因其他医疗状况住院期间发生了AMI。这些患者与那些因AMI前往医院就诊的患者有很大不同。院内组30天死亡率的比值比更高（比值比，3.6；95%置信区间，3.1 - 4.3；P <.001），在统计调整后仍然更高（比值比，2.0；95%置信区间，1.7 - 2.4；P <.001）。
尽管大多数注意力都集中在通过社区紧急医疗系统或急诊科入院的AMI患者身上，但在因其他医疗问题住院期间发生的AMI是一个重要的临床问题。
