Beaglehole R
Br Med J (Clin Res Ed). 1986 Jan 4;292(6512):33-5. doi: 10.1136/bmj.292.6512.33.
The contribution of resuscitation before admission to hospital, coronary care units, treatment with beta blockers after myocardial infarction, coronary artery bypass surgery, and the treatment of hypertension to the decline in mortality from coronary heart disease in Auckland between 1974 and 1981 was assessed by using data from several population based studies. There were 126 fewer deaths from coronary heart disease in Auckland in 1981 than expected from the 1974 rates among people less than 70 years. The specific medical interventions probably accounted for about 51 (40%) of the 126 fewer deaths. Local data indicate that resuscitation before admission to hospital was responsible for 20 (16%) of the 126 fewer deaths. Projections based on local data and trials carried out overseas suggest that up to 15 (12%) of the 126 fewer deaths were due to the treatment of hypertension. Coronary care units and the use of beta blockers after myocardial infarction were estimated to be responsible for six (5%) and three (2%) of the 126 fewer deaths, respectively. The impact of coronary surgery was especially difficult to determine in the absence of appropriate randomised controlled trial data. Estimates of its contribution ranged from seven to 23 (5% to 18%) of the 126 fewer deaths.
利用多项基于人群的研究数据，评估了1974年至1981年间，入院前复苏、冠心病监护病房、心肌梗死后使用β受体阻滞剂治疗、冠状动脉搭桥手术以及高血压治疗对奥克兰冠心病死亡率下降的贡献。1981年，奥克兰70岁以下人群中，冠心病死亡人数比根据1974年死亡率预期的死亡人数少126人。特定的医疗干预措施可能占这减少的126例死亡人数中的约51例（40%）。当地数据表明，入院前复苏导致了这减少的126例死亡中的20例（16%）。根据当地数据和海外进行的试验推测，这减少的126例死亡中，多达15例（12%）归因于高血压治疗。冠心病监护病房以及心肌梗死后使用β受体阻滞剂估计分别导致了这减少的126例死亡中的6例（5%）和3例（2%）。在缺乏适当随机对照试验数据的情况下，冠状动脉手术的影响尤其难以确定。其贡献的估计值在这减少的126例死亡中的7至23例（5%至18%）之间。
