Gomez-Marin O, Folsom A R, Kottke T E, Wu S C, Jacobs D R, Gillum R F, Edlavitch S A, Blackburn H
N Engl J Med. 1987 May 28;316(22):1353-9. doi: 10.1056/NEJM198705283162201.
The mortality rate associated with coronary heart disease in the United States has declined steadily since 1968, but the reasons for this favorable trend have not been completely elucidated. In particular, it is not clear to what extent the decline reflects decreasing incidence as opposed to improved survival. To assess whether improved survival after myocardial infarction has contributed to the decline, the Minnesota Heart Survey compared the four-year survival rate in patients discharged with a diagnosis of acute myocardial infarction from hospitals in the Twin Cities area in 1970 and 1980. After adjustment for clinical characteristics related to outcome, the survival rate among patients with a definite myocardial infarction was significantly higher in the 1980 than in the 1970 group. The four-year survival for men was 35 percent better in the 1980 than in the 1970 group (95 percent confidence interval, 21 to 50 percent), and for women it was 27 percent better (95 percent confidence interval, 1 to 46 percent). Improvement in survival during the period of hospitalization accounted for 70 percent of the overall gain in survival between 1970 and 1980 in men and for virtually all of the gain in women. We conclude that improved long-term survival among patients with acute myocardial infarction has made an important contribution to the decline in mortality from coronary disease.
自1968年以来，美国冠心病相关死亡率持续下降，但这一良好趋势的原因尚未完全阐明。特别是，目前尚不清楚死亡率下降在多大程度上反映了发病率的降低，而非生存率的提高。为评估心肌梗死后生存率的提高是否导致了死亡率的下降，明尼苏达心脏调查比较了1970年和1980年在双城地区医院诊断为急性心肌梗死出院患者的四年生存率。在对与预后相关的临床特征进行调整后，1980年确诊心肌梗死患者的生存率显著高于1970年组。1980年男性的四年生存率比1970年组提高了35%（95%置信区间为21%至50%），女性提高了27%（95%置信区间为1%至46%）。住院期间生存率的提高占1970年至1980年男性总体生存率提高的70%，而女性的生存率提高几乎完全归因于此。我们得出结论，急性心肌梗死患者长期生存率的提高对冠心病死亡率的下降做出了重要贡献。
