Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, D-48149 Muenster, Germany.
Eur Heart J. 2014 Apr;35(15):979-88. doi: 10.1093/eurheartj/ehu043. Epub 2014 Feb 20.
Recent guidelines on acute myocardial infarction (AMI) are based on randomized clinical trials (RCTs) and registries with selected patients, and may therefore not represent 'real-life'. This analysis shows for the first time nationwide trends in AMI from Germany.
We were provided with data on all in-patient hospitalizations by the Federal Statistical Office. All hospitalized cases with AMI (onset of symptoms <28 days) from the years 2005, 2007, and 2009 were analysed regarding morbidity, in-hospital mortality, treatments, and costs. Analysis of a total of 16.1, 16.6, and 17.2 million hospitalizations showed the proportion of coded AMI to remain relatively constant (1276, 1272, and 1181 per 100 000 hospitalizations in 2005, 2007, and 2009). The proportion of ST-elevation AMI decreased over time (STEMI; 631, 546, and 454 per 100 000 hospitalizations),while non-ST-elevation AMI increased (NSTEMI; 645, 726, and 727 per 100 000 hospitalizations). The proportion of older patients >75 years (+4.6%), of comorbidities such as hypertension (+5.8%), diabetes (+17.7%), left ventricular failure (+19.8%), peripheral artery disease (+13.3%), and chronic kidney disease (+165.4%) increased as well. In-hospital mortality remained relatively stable during this period in AMI cases overall (11.1, 10.7, 10.8%) but changed slightly in STEMI (11.2, 11.9, 12.2%) and NSTEMI (11.0, 9.9, 9.9%). Causing about 1.2% of hospitalizations, AMI accounted for 2.5% (1.2 billion €) of in-hospital health expenses.
This hospitalization-based analysis revealed a marked increase of NSTEMI among constant AMI frequency. Despite all current efforts, in-hospital mortality was stagnating on a high level compared with data of RCTs.
最近关于急性心肌梗死（AMI）的指南是基于随机临床试验（RCT）和有选择患者的登记处，因此可能无法代表“真实生活”。本分析首次展示了德国全国范围内 AMI 的趋势。
我们从联邦统计局获得了所有住院患者的数据。对 2005 年、2007 年和 2009 年所有发病症状<28 天的住院 AMI 病例进行了发病率、住院死亡率、治疗和费用分析。共分析了 1610 万、1660 万和 1720 万例住院治疗，结果表明编码 AMI 的比例相对稳定（2005 年、2007 年和 2009 年每 10 万人中有 1276、1272 和 1181 例）。ST 段抬高型 AMI 的比例随时间下降（STEMI；每 10 万人中有 631、546 和 454 例），而非 ST 段抬高型 AMI 增加（NSTEMI；每 10 万人中有 645、726 和 727 例）。>75 岁的老年患者比例（增加 4.6%）、高血压（增加 5.8%）、糖尿病（增加 17.7%）、左心室衰竭（增加 19.8%）、外周动脉疾病（增加 13.3%）和慢性肾病（增加 165.4%）等合并症的比例也有所增加。在此期间，AMI 患者的住院死亡率总体保持相对稳定（11.1%、10.7%、10.8%），但 STEMI（11.2%、11.9%、12.2%）和 NSTEMI（11.0%、9.9%、9.9%）略有变化。AMI 约占住院医疗费用的 2.5%（120 亿欧元），占住院治疗的 1.2%。
基于住院治疗的分析显示，NSTEMI 在 AMI 发病率不变的情况下显著增加。尽管目前做出了所有努力，但与 RCT 数据相比，住院死亡率仍停留在较高水平。
