Laboratoire d'épidémiologie et de santé publique, Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France.
Eur J Prev Cardiol. 2013 Apr;20(2):275-82. doi: 10.1177/2047487312438983. Epub 2012 Feb 7.
In France, there is a large north-to-south, decreasing gradient in case fatality rates of hospitalized patients for an acute coronary event. This gradient may be explained by differences in the presenting patients' clinical, biological and electrocardiographic characteristics.
To compare the characteristics of patients hospitalized for an acute episode of coronary insufficiency in three regions of France with contrasting fatality rates.
We assessed all men and women (aged 35-74 years) covered by the MONICA registries in three geographical areas (north, east and south-west France) and hospitalized in 2006 for a first acute coronary event. The symptoms, electrocardiogram features, left ventricular ejection fraction (LVEF) and troponin levels were systematically transcribed from medical files. Vital status was followed up for one year.
Fatality rates at 28 days and 1 year were higher in the north (7% and 12%, respectively) than in the east (5% and 7%) and in the south-west (2% and 5%). Major symptoms (such as cardiac arrest, acute pulmonary oedema and cardiac shock), altered LVEF and ST+ myocardial infarction (STEMI) were more frequent in the north than in the south-west (all p < 0.0001) - pointing to marked inter-regional differences in the presentation of acute coronary syndromes (ACSs). In multivariate analyses, age, major symptoms, altered LVEF and STEMI remained strongly associated with 28-day lethality, whereas the relationship with geographical area was attenuated. Similar results were observed for 1-year outcomes.
The clinical, biological and electrocardiographic presentations of hospitalized incident ACSs differ from one region of France to another. These differences explain (at least in part) the 28-day and 1-year decreasing case fatality gradient in hospitalized patients from northern France to south-western France.
在法国，因急性冠脉事件住院患者的病死率呈由北向南逐渐降低的趋势。这种梯度可能与就诊患者的临床、生物学和心电图特征的差异有关。
比较法国三个地区住院的急性冠脉综合征患者的特征，这些地区的病死率存在差异。
我们评估了 MONICA 登记处涵盖的所有年龄在 35-74 岁的男性和女性，他们在 2006 年因首次急性冠脉事件住院。症状、心电图特征、左心室射血分数（LVEF）和肌钙蛋白水平均从病历中系统转录。对生存状态进行了为期一年的随访。
28 天和 1 年病死率在北部（分别为 7%和 12%）高于东部（5%和 7%）和西南部（2%和 5%）。北部比西南部更常见主要症状（如心脏骤停、急性肺水肿和心源性休克）、LVEF 改变和 ST+心肌梗死（STEMI）（均 P<0.0001）——表明急性冠脉综合征（ACS）的表现存在明显的区域间差异。多变量分析显示，年龄、主要症状、LVEF 改变和 STEMI 与 28 天病死率密切相关，而与地理区域的关系则减弱。1 年结果观察到类似的结果。
住院急性 ACS 患者的临床表现、生物学和心电图表现因地区而异。这些差异至少部分解释了法国北部到西南部住院患者病死率的 28 天和 1 年逐渐降低的梯度。
