Kuch Bernhard, von Scheidt Wolfgang, Ehmann Anja, Kling Birgitt, Greschik Claudia, Hoermann Allmut, Meisinger Christa
I. Medizinische Klinik, Klinikum Augsburg, teaching hospital of Ludwig Maximilians University München, Augsburg, Germany.
Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):313-9. doi: 10.1161/CIRCOUTCOMES.108.831529. Epub 2009 Jun 2.
No data exist regarding time trends of 28-day case fatality (CF) of patients with presumed acute myocardial infarction (AMI) using epidemiological criteria, clinical criteria, and AMI classification after validation of presumed in-hospital AMI-related deaths (gold-standard criteria).
From 1985 to 2004, we prospectively examined all 9210 AMI patients consecutively hospitalized in a large teaching hospital by using a broad epidemiological AMI definition (WHO-MONICA). Twenty-eight-day CF decreased significantly from 32% in 1985-1986 to 18% in 2003-2004, mostly because of a reduction in early deaths (<24 hours). When applying the clinical AMI definition, most of the early deaths were not counted as AMI related. A retrospective validation process from a sample of all early deceased patients by the epidemiological AMI definition (388/2076) and a prospective validation of the complete cohort in 2005-2006 revealed that only about 50% of early deaths are reclassified as a real fatal AMI using newer criteria resulting in a 28-day CF of 23% in 1985-1986 and 11% in 2005-2006. The difference between the AMI 28-day CF by applying gold-standard criteria and the clinical AMI 28-day CF (18% in 1985-1986 and 7% in 2005-2006) has decreased during recent years.
The application of broad epidemiological criteria for AMI overestimates 28-day CF by almost 2-fold compared with gold-standard criteria (after validation of early deaths) and almost 3-fold compared to the clinical definition. The growing similarity in 28-day CF between the clinically based definition and the gold-standard criteria implies that recent clinical-based registries may represent a realistic picture of trends regarding in-hospital AMI mortality.
对于疑似急性心肌梗死（AMI）患者，在使用流行病学标准、临床标准以及对院内疑似AMI相关死亡进行验证后的AMI分类（金标准）的情况下，尚无关于28天病死率（CF）时间趋势的数据。
1985年至2004年期间，我们采用广泛的流行病学AMI定义（世界卫生组织-莫尼卡方案），对一家大型教学医院连续收治的9210例AMI患者进行了前瞻性研究。28天CF从1985 - 1986年的32%显著降至2003 - 2004年的18%，主要原因是早期死亡（<24小时）减少。应用临床AMI定义时，大多数早期死亡未被计为与AMI相关。对所有早期死亡患者样本采用流行病学AMI定义进行回顾性验证（388/2076），以及在2005 - 2006年对整个队列进行前瞻性验证，结果显示，使用更新标准后，只有约50%的早期死亡被重新分类为真正的致命性AMI，导致1985 - 1986年的28天CF为23%，2005 - 2006年为11%。近年来，采用金标准的AMI 28天CF与临床AMI 28天CF（1985 - 1986年为18%，2005 - 2006年为7%）之间的差异有所减小。
与金标准（早期死亡验证后）相比，应用广泛的流行病学AMI标准高估28天CF近2倍，与临床定义相比高估近3倍。基于临床的定义与金标准在28天CF上的相似性日益增加，这意味着近期基于临床的登记可能代表了院内AMI死亡率趋势的实际情况。
