MPH, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Circulation. 2010 Feb 23;121(7):863-9. doi: 10.1161/CIRCULATIONAHA.109.897249. Epub 2010 Feb 8.
In 2000, the definition of myocardial infarction (MI) changed to rely on troponin rather than creatine kinase (CK) and its MB fraction (CK-MB). The implications of this change on trends in MI incidence and outcome are not defined.
This was a community study of 2816 patients hospitalized with incident MI from 1987 to 2006 in Olmsted County, Minnesota, with prospective measurements of troponin and CK-MB from August 2000 forward. Outcomes were MI incidence, severity, and survival. After troponin was introduced, 278 (25%) of 1127 incident MIs met only troponin-based criteria. When cases meeting only troponin criteria were included, incidence did not change between 1987 and 2006. When restricted to cases defined by CK/CK-MB, the incidence of MI declined by 20%. The incidence of non-ST-segment elevation MI increased markedly by relying on troponin, whereas that of ST-segment elevation MI declined regardless of troponin. The age- and sex-adjusted hazard ratio of death within 30 days for an infarction occurring in 2006 (compared with 1987) was 0.44 (95% confidence interval, 0.30 to 0.64). Among 30-day survivors, survival did not improve, but causes of death shifted from cardiovascular to noncardiovascular (P=0.001). Trends in long-term survival among 30-day survivors were similar regardless of troponin.
Over the last 2 decades, a substantial change in the epidemiology of MI occurred that was only partially mediated by the introduction of troponin. Non-ST-segment elevation MIs now constitute the majority of MIs. Although the 30-day case fatality improved markedly, long-term survival did not change, and the cause of death shifted from cardiovascular to noncardiovascular.
2000 年，心肌梗死（MI）的定义改为依赖肌钙蛋白而非肌酸激酶（CK）及其 MB 片段（CK-MB）。这一变化对 MI 发病率和结局趋势的影响尚不清楚。
这是明尼苏达州奥姆斯特德县的一项社区研究，对 1987 年至 2006 年间因首次发生 MI 住院的 2816 例患者进行了研究，前瞻性测量了 2000 年 8 月以后的肌钙蛋白和 CK-MB。结局是 MI 的发生率、严重程度和存活率。引入肌钙蛋白后，1127 例首发 MI 中仅有 278 例（25%）仅符合肌钙蛋白标准。当纳入仅符合肌钙蛋白标准的病例时，1987 年至 2006 年期间的发病率没有变化。当仅用 CK/CK-MB 定义病例时，MI 的发病率下降了 20%。由于依赖肌钙蛋白，非 ST 段抬高型 MI 的发病率显著增加，而 ST 段抬高型 MI 的发病率则不论是否使用肌钙蛋白都有所下降。2006 年（与 1987 年相比）发生的梗塞 30 天内死亡的年龄和性别调整危险比为 0.44（95%置信区间，0.30 至 0.64）。在 30 天存活者中，存活率没有提高，但死亡原因从心血管转为非心血管（P=0.001）。30 天存活者的长期生存趋势与肌钙蛋白无关。
在过去的 20 年中，MI 的流行病学发生了重大变化，而肌钙蛋白的引入只是部分导致了这种变化。非 ST 段抬高型 MI 现在构成了 MI 的大多数。尽管 30 天病死率显著降低，但长期存活率没有改变，死亡原因从心血管转为非心血管。
