人口趋势对急性心肌梗死发病率和结局的影响。
Population trends in the incidence and outcomes of acute myocardial infarction.
机构信息
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
出版信息
N Engl J Med. 2010 Jun 10;362(23):2155-65. doi: 10.1056/NEJMoa0908610.
BACKGROUND
Few studies have characterized recent population trends in the incidence and outcomes of myocardial infarction.
METHODS
We identified patients 30 years of age or older in a large, diverse, community-based population who were hospitalized for incident myocardial infarction between 1999 and 2008. Age- and sex-adjusted incidence rates were calculated for myocardial infarction overall and separately for ST-segment elevation and non-ST-segment elevation myocardial infarction. Patient characteristics, outpatient medications, and cardiac biomarker levels during hospitalization were identified from health plan databases, and 30-day mortality was ascertained from administrative databases, state death data, and Social Security Administration files.
RESULTS
We identified 46,086 hospitalizations for myocardial infarctions during 18,691,131 person-years of follow-up from 1999 to 2008. The age- and sex-adjusted incidence of myocardial infarction increased from 274 cases per 100,000 person-years in 1999 to 287 cases per 100,000 person-years in 2000, and it decreased each year thereafter, to 208 cases per 100,000 person-years in 2008, representing a 24% relative decrease over the study period. The age- and sex-adjusted incidence of ST-segment elevation myocardial infarction decreased throughout the study period (from 133 cases per 100,000 person-years in 1999 to 50 cases per 100,000 person-years in 2008, P<0.001 for linear trend). Thirty-day mortality was significantly lower in 2008 than in 1999 (adjusted odds ratio, 0.76; 95% confidence interval, 0.65 to 0.89).
CONCLUSIONS
Within a large community-based population, the incidence of myocardial infarction decreased significantly after 2000, and the incidence of ST-segment elevation myocardial infarction decreased markedly after 1999. Reductions in short-term case fatality rates for myocardial infarction appear to be driven, in part, by a decrease in the incidence of ST-segment elevation myocardial infarction and a lower rate of death after non-ST-segment elevation myocardial infarction.
背景
很少有研究描述心肌梗死发病率和结局的近期人群趋势。
方法
我们在一个大型、多样化的社区人群中确定了 30 岁或以上的患者，他们在 1999 年至 2008 年间因新发心肌梗死住院。计算了心肌梗死的年龄和性别调整发病率，包括 ST 段抬高型和非 ST 段抬高型心肌梗死。从健康计划数据库中确定了患者特征、门诊药物和住院期间的心脏生物标志物水平，从行政数据库、州死亡数据和社会保障管理局文件中确定了 30 天死亡率。
结果
我们在 1999 年至 2008 年的 18691131 人年随访中确定了 46086 例心肌梗死住院。年龄和性别调整的心肌梗死发病率从 1999 年的每 10 万人 274 例增加到 2000 年的每 10 万人 287 例，此后每年下降，至 2008 年每 10 万人 208 例，研究期间相对下降 24%。ST 段抬高型心肌梗死的年龄和性别调整发病率在整个研究期间下降（从 1999 年的每 10 万人 133 例降至 2008 年的每 10 万人 50 例，线性趋势 P<0.001）。2008 年 30 天死亡率明显低于 1999 年（调整后的优势比，0.76；95%置信区间，0.65 至 0.89）。
结论
在一个大型社区人群中，2000 年后心肌梗死的发病率显著下降，ST 段抬高型心肌梗死的发病率在 1999 年后明显下降。心肌梗死短期病死率的下降部分归因于 ST 段抬高型心肌梗死发病率的下降和非 ST 段抬高型心肌梗死死亡率的降低。
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