Goldberg R J, Gore J M, Alpert J S, Dalen J E
JAMA. 1986;255(20):2774-9.
A communitywide study was conducted in all 16 acute general hospitals in the metropolitan Worcester, Mass, area during the calendar years 1975, 1978, and 1981 to examine time trends in the attack and case-fatality rates of patients hospitalized with validated acute myocardial infarction as well as of the occurrence of out-of-hospital coronary heart disease (CHD) deaths. Between 1975 and 1981, there was an increase in the age-adjusted attack rates of initial events of acute myocardial infarction (1975, 254/100,000; 1981, 280/100,000) as well as recurrent events (1975, 133/100,000; 1981, 156/100,000). These overall increases were due to an increase among those 65 years of age and older, with no significant changes observed in those less than 65 years old. The age-adjusted in-hospital case-fatality rates declined from 22.1% in 1975 to 20.3% in 1978 and 17.4% in 1981. In examining long-term prognosis, no significant differences were seen over an eight-year follow-up period between patients discharged in 1975, 1978, and 1981. The age-adjusted mortality rates of out-of-hospital CHD deaths significantly declined between 1975 (229/100,000) and 1981 (147/100,000). The results of this population-based survey suggest that recently observed declines in the mortality rates of CHD may reflect decreases in out-of-hospital coronary deaths and improving trends in the in-hospital survival of patients with acute myocardial infarction.
1975年、1978年和1981年期间，在马萨诸塞州伍斯特市大都会区的所有16家急性综合医院开展了一项全社区范围的研究，以调查确诊为急性心肌梗死住院患者的发病率和病死率的时间趋势，以及院外冠心病（CHD）死亡的发生情况。1975年至1981年期间，急性心肌梗死首发事件（1975年，254/10万；1981年，280/10万）以及复发事件（1975年，133/10万；1981年，156/10万）的年龄调整发病率有所上升。这些总体上升是由于65岁及以上人群发病率上升，65岁以下人群未观察到显著变化。年龄调整后的住院病死率从1975年的22.1%降至1978年的20.3%和1981年的17.4%。在检查长期预后时，1975年、1978年和1981年出院的患者在八年随访期内未观察到显著差异。1975年（229/10万）至1981年（147/10万）期间，院外冠心病死亡的年龄调整死亡率显著下降。这项基于人群的调查结果表明，最近观察到的冠心病死亡率下降可能反映了院外冠状动脉死亡的减少以及急性心肌梗死患者住院生存率的改善趋势。
