Department of Cardiology, Odense University Hospital, Odense, Denmark.
Department of Nuclear Medicine, Odense University Hospital and Center of Health Economics Research, Odense, Denmark.
Am J Med. 2015 Aug;128(8):852-60. doi: 10.1016/j.amjmed.2015.01.044. Epub 2015 Mar 27.
Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients.
During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System.
Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045).
The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI.
自从心肌梗死的通用定义出现以来，已经开发出了更敏感的肌钙蛋白检测方法。这些新方法的出现如何影响急性冠状动脉综合征各组成部分的比例和临床特征，尚未在未经选择的医院患者中进行前瞻性研究。
在 2010 年，我们评估了在一家大学医院测量了心脏肌钙蛋白 I 的所有患者。急性心肌梗死（ST 段抬高型心肌梗死 [STEMI] 或非 ST 段抬高型心肌梗死 [NSTEMI]）的诊断是基于心脏肌钙蛋白 I 的升高和/或降低以及心脏缺血特征确立的。心脏肌钙蛋白 I 值低于心肌梗死诊断界值但有不稳定胸痛的患者被诊断为不稳定型心绞痛。急性冠状动脉综合征的定义包括不稳定型心绞痛、NSTEMI 和 STEMI。死亡率数据来自丹麦民事个人登记系统。
在连续 3762 例患者中，有 516 例患有急性冠状动脉综合征。不稳定型心绞痛占 7%，NSTEMI 占 67%，STEMI 占 26%。与不稳定型心绞痛和 STEMI 患者相比，NSTEMI 患者年龄更大，女性更多，合并症更多。中位随访 3.2 年后，195 例患者死亡：不稳定型心绞痛患者为 14%，NSTEMI 患者为 45%，STEMI 患者为 25%。年龄调整的对数秩检验显示死亡率存在差异：NSTEMI 与不稳定型心绞痛（P =.0091）和 NSTEMI 与 STEMI（P =.0045）。
通用定义的应用以及使用当代肌钙蛋白检测方法似乎降低了不稳定型心绞痛患者的比例，使 NSTEMI 患者受益。尽管如此，NSTEMI 患者的死亡率仍持续高于 STEMI 患者。
