Snorrason Einar Logi, Johannnesdottir Bergros Kristin, Aspelund Thor, Gudnason Vilmundur, Andersen Karl
Faculty of Medicine, University of Iceland.
Haukeland University Hospital, Bergen, Norway.
Laeknabladid. 2018 Nov;104(11):491-497. doi: 10.17992/lbl.2018.11.203.
Despite the decreasing incidence rate of acute coronary syndromes worldwide, the incidence of NSTEMI (Non- ST elevation myocardial infarction) has increased relative to STEMI (ST elevation myocardial infarction). The aim of this study was to compare long-term survival rates of NSTEMI and STEMI patients and to explore the effects of risk factors on survival.
All patients hospitaized for acute myocardial infarction at Landspitali University Hospital during the calendar year of 2006 were included in the study. Information about risk factors was obtained using electronic medical records. The primary endpoint was all cause mortality, the secondary endpoint was defined as death or myocardial infartion. Patients were followed up to January 1st 2015.
Among 447 patients diagnosed with acute myocardial infarction in Iceland in 2006, 280 patients were diagnosed with NSTEMI (I21.4) and 167 with STEMI (I21, I21.9). NSTEMI and STEMI incidence rates per 100.000 inhabitants in Iceland were 91.3 and 55.9, respectively. The mean age of NSTEMI patients was 73.0 years, women were on average 8.4 years older than men. The mean age of STEMI patients was 65.3 years, women were on average 7.3 years older than men. The five-year survival rate for NSTEMI patients was 51%, 42% among women and 57% among men. The five-year survival rate for STEMI patients was 77%, 68% among women and 80% among men. Five year age-adjusted survival rates were higher for STEMI than NSTEMI (logrank: p <0.01).
The incidence of NSTEMI was higher than that of STEMI in Iceland in 2006. The worse prognosis of women as compared to men was due to the higher mean age of women. Overall, long-term survival of NSTEMI patients was worse than that of STEMI patients even after adjustment for difference in age.
尽管全球急性冠状动脉综合征的发病率在下降，但非ST段抬高型心肌梗死（NSTEMI）的发病率相对于ST段抬高型心肌梗死（STEMI）有所上升。本研究的目的是比较NSTEMI和STEMI患者的长期生存率，并探讨危险因素对生存的影响。
纳入2006年全年在冰岛国家大学医院因急性心肌梗死住院的所有患者。使用电子病历获取有关危险因素的信息。主要终点是全因死亡率，次要终点定义为死亡或心肌梗死。对患者随访至2015年1月1日。
2006年在冰岛诊断为急性心肌梗死的447例患者中，280例诊断为NSTEMI（I21.4），167例诊断为STEMI（I21，I21.9）。冰岛每10万居民中NSTEMI和STEMI的发病率分别为91.3和55.9。NSTEMI患者的平均年龄为73.0岁，女性平均比男性大8.4岁。STEMI患者的平均年龄为65.3岁，女性平均比男性大7.3岁。NSTEMI患者的五年生存率为51%，女性为42%，男性为57%。STEMI患者的五年生存率为77%，女性为68%，男性为80%。STEMI的五年年龄调整生存率高于NSTEMI（对数秩检验：p<0.01）。
2006年冰岛NSTEMI的发病率高于STEMI。女性预后比男性差是因为女性平均年龄较高。总体而言，即使在调整年龄差异后，NSTEMI患者的长期生存率仍比STEMI患者差。
