Ericsson C G, Lindvall B, Olsson G, Rehnqvist N, Strandberg L E, Svensson G, Erhardt L
Department of Medicine, Danderyd Hospital, Sweden.
Acta Med Scand. 1988;224(6):507-13.
Data on the 2,008 patients in the Swedish Co-operative Study from 1969 were compared with 773 consecutive cases with definite myocardial infarction (MI) admitted to the coronary care unit (CCU) of Danderyd Hospital in Stockholm 1984-85. We found a significant decrease in hospital mortality from 26.6% to 12.9% despite the admission of older patients to our CCU. Mean age for men was 63.8 vs. 65.6 years and for women, 69.8 vs. 72.3. The incidence of previous hypertension and diabetes was higher and the incidence of heart failure and angina lower in 1984-85. No differences were noted as regards the incidence of ventricular fibrillation, atrial fibrillation and AV-block III in the acute phase despite a much more frequent use of antiarrhythmics in 1969 (33% vs. 4%). A decreased use of cardiac glucosides was also noted (34% vs. 16%). Asystole, however, was noted in 10% of the patients in 1969 compared with 3% in our patients. beta-Adrenergic blockers were not used in 1969 but commonly given in 1984-85 (67%), also in those with heart failure (54%). Delay between onset of symptoms and admission was longer in 1969, 47% being admitted within 6 hours compared with 75% in 1984-85. In conclusion, our study shows a marked change in the use of various cardiac drugs in the treatment of MI. Differences between the populations as regards mortality and different clinical findings are more difficult to evaluate and may also be explained by change in the selection of patients treated in the CCU.
将1969年瑞典合作研究中2008例患者的数据与1984 - 1985年斯德哥尔摩丹德吕德医院冠心病监护病房（CCU）收治的773例确诊心肌梗死（MI）的连续病例进行了比较。我们发现，尽管我们CCU收治的患者年龄更大，但医院死亡率仍显著下降，从26.6%降至12.9%。男性的平均年龄为63.8岁对65.6岁，女性为69.8岁对72.3岁。1984 - 1985年，既往高血压和糖尿病的发病率较高，而心力衰竭和心绞痛的发病率较低。尽管1969年抗心律失常药物的使用频率更高（33%对4%），但急性期室颤、房颤和三度房室传导阻滞的发生率并无差异。还注意到强心苷的使用减少（34%对16%）。然而，1969年10%的患者出现心搏停止，而我们的患者中这一比例为3%。1969年未使用β受体阻滞剂，但在1984 - 1985年普遍使用（67%），心力衰竭患者中也有54%使用。1969年症状出现至入院的延迟时间更长，47%的患者在6小时内入院，而1984 - 1985年这一比例为75%。总之，我们的研究表明，在心肌梗死治疗中各种心脏药物的使用发生了显著变化。不同人群在死亡率和不同临床发现方面的差异更难评估，也可能是由于冠心病监护病房治疗患者选择的变化所致。
