Department of Medicine, Aga Khan University, Karachi, Pakistan.
Division of Cardiology, Department of Medicine, Duke University, Duke Global Health Institute, Duke Clinical Research Institute, Durham, NC, USA.
Glob Heart. 2022 Aug 18;17(1):58. doi: 10.5334/gh.1147. eCollection 2022.
Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988-2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan.
We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality.Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases ( 0.53-1.00).
The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52-70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all p < 0.001). In-hospital mortality rates declined significantly between 1988-1997 and 2008-2018 (13.8% to 9.2%, p < 0.001).
The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs.
在中低收入国家（LMICs）最近的流行病学转变中，有关急性心肌梗死（AMI）模式趋势的数据很少。为了了解 1988 年至 2018 年期间 AMI 特征和结局的时间疾病模式，我们使用了巴基斯坦一家大型三级保健中心的数字化遗留临床数据。
我们审查了阿克巴大学医院的数字化健康信息采集系统，并获得了创建主数据集的结构化元素。我们纳入了 1988 年 1 月 1 日至 2018 年 12 月 31 日期间出院的年龄＞18 岁的患者索引入院，主要出院诊断为 AMI（使用 ICD-9 诊断）。评估的结局为院内死亡率。从电子数据库中得出的临床特征与随机样本病例的图表审查进行了验证（0.53-1.00）。
最终人群包括 14601 名患者，其中 30.6%（n=4470）为女性，52.4%（n=7651）为 ST 段抬高型心肌梗死，47.6%（n=6950）为非 ST 段抬高型心肌梗死。就诊时的中位数（IQR）年龄为 61（52-70）岁。总体未调整的院内死亡率为 10.3%。在整个时间段内，以下特征的趋势均呈上升趋势：年龄、女性比例、高血压、糖尿病、非 ST 段抬高型心肌梗死的比例（均 p＜0.001）。1988-1997 年至 2008-2018 年期间，院内死亡率显著下降（13.8%降至 9.2%，p＜0.001）。
在过去的三十年中，巴基斯坦一家三级保健中心的 AMI 模式发生了变化，同时院内死亡率也有所下降。临床数字化数据为了解 LMIC 中的疾病模式提供了独特的机会。
