Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Circulation. 2011 Jan 4;123(1):46-52. doi: 10.1161/CIRCULATIONAHA.110.964999. Epub 2010 Dec 20.
Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered. Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital.
Record linkage documented all case subjects 35 to 84 years of age in Sweden during 1991 to 2006 with a first major coronary event (out-of-hospital coronary death or hospitalization for acute myocardial infarction). Of the 384 597 cases identified, 111 319 (28.9%) died out of the hospital, and another 36 552 (9.5%) died in the hospital or within 28 days of hospitalization. From 1991 to 2006, out-of hospital deaths as a proportion of all major coronary events declined from 30.5% to 25.6% (adjusted mean annual decrease 2.2%, 95% confidence interval 2.1% to 2.4%), however, with a larger decline in 28-day case fatality in hospitalized cases (adjusted mean annual decrease 5.8%, 95% confidence interval 5.5% to 6.0%). As a result of the faster decline in in-hospital deaths, the relative contribution of out-of-hospital deaths to overall case fatality increased, particularly among younger individuals (eg, among those 35 to 54 years of age, no more than 10.8% of all deaths occurred in hospitalized cases during 2003-2006). Although female sex (odds ratio 0.85, 95% confidence interval 0.83 to 0.87) and older age (odds ratio 0.972, 95% confidence interval 0.971 to 0.974 per year) were associated with lower risk for initial out-of-hospital death, each successive calendar year was associated with increased risk (odds ratio 1.041, 95% confidence interval 1.038 to 1.044).
The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals.
当仅考虑那些存活并到达医院的患者时，与首次冠状动脉事件相关的病死率往往被低估。很少有研究检测过院外发生的主要冠状动脉事件相关病死率的长期趋势。
记录关联确定了瑞典 1991 年至 2006 年期间年龄在 35 岁至 84 岁之间的所有首次主要冠状动脉事件（院外冠状动脉死亡或因急性心肌梗死住院）的病例患者。在所确定的 384597 例病例中，111319 例（28.9%）在院外死亡，另有 36552 例（9.5%）在医院或住院后 28 天内死亡。从 1991 年到 2006 年，院外死亡占所有主要冠状动脉事件的比例从 30.5%降至 25.6%（调整后平均每年下降 2.2%，95%置信区间为 2.1%至 2.4%），但住院患者的 28 天病死率下降幅度更大（调整后平均每年下降 5.8%，95%置信区间为 5.5%至 6.0%）。由于院内死亡下降速度更快，院外死亡对总病死率的相对贡献增加，尤其是在年轻人群中（例如，在 35 至 54 岁的人群中，2003 年至 2006 年期间，所有死亡中只有不到 10.8%发生在住院患者中）。尽管女性（比值比 0.85，95%置信区间 0.83 至 0.87）和年龄较大（比值比 0.972，95%置信区间 0.971 至 0.974 每年）与初始院外死亡风险较低相关，但每过一年，风险都会增加（比值比 1.041，95%置信区间 1.038 至 1.044）。
绝大多数致命性冠状动脉事件发生在医院之外，且这一比例正在增加，尤其是在年轻人群中。
