Gurwitz J H, Goldberg R J, Chen Z, Gore J M, Alpert J S
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Arch Intern Med. 1994 Oct 10;154(19):2202-8.
While age-related differences in patterns of care for acute myocardial infarction have been demonstrated, temporal trends in clinical outcome for patients in different age groups have not been carefully examined.
We analyzed data collected as part of an ongoing communitywide study of 5480 patients hospitalized with validated acute myocardial infarction in Worcester, Mass, during 7 selected years spanning a 15-year period (1975 through 1990). Patients were stratified into three age groups: less than 65 years (n = 2220), 65 through 74 years (n = 1595), and 75 years or older (n = 1665). Within each age group, the odds of in-hospital death were determined by study year, with adjustments for selected demographic, clinical, and hospital characteristics.
For patients less than age 65 years, the odds of dying during the acute hospital phase of myocardial infarction were reduced for all study years relative to the reference year (1975), reaching their lowest level in 1990 (adjusted odds ratio [OR], 0.16; 95% confidence interval [CI], 0.06 to 0.48). For patients aged 65 through 74 years, the odds of dying declined among patients hospitalized in 1978 (adjusted OR, 0.71; 95% CI, 0.39 to 1.29) and 1981 (adjusted OR, 0.36; 95% CI, 0.19 to 0.66) but remained essentially unchanged during the subsequent study years through 1990. For patients 75 years of age or older, the odds of dying declined through 1984 (adjusted OR, 0.42; 95% CI, 0.25 to 0.72) but increased over the following study years: 1986, 1988, and 1990.
While the risk of in-hospital death following acute myocardial infarction has recently declined for patients less than 65 years of age, improvements have not been realized for older age groups. Current patterns of management of acute myocardial infarction in older patients require reexamination.
虽然已证实急性心肌梗死的护理模式存在年龄相关差异，但不同年龄组患者临床结局的时间趋势尚未得到仔细研究。
我们分析了作为一项正在进行的社区范围研究的一部分收集的数据，该研究涉及马萨诸塞州伍斯特市在15年期间（1975年至1990年）选定的7年中因经证实的急性心肌梗死住院的5480例患者。患者被分为三个年龄组：小于65岁（n = 2220）、65至74岁（n = 1595）和75岁及以上（n = 1665）。在每个年龄组内，根据研究年份确定住院死亡几率，并对选定的人口统计学、临床和医院特征进行调整。
对于小于65岁的患者，与参考年份（1975年）相比，在所有研究年份中心肌梗死急性住院期死亡几率均降低，在1990年达到最低水平（调整后的优势比[OR]，0.16；95%置信区间[CI]，0.06至0.48）。对于65至74岁的患者，1978年（调整后的OR，0.71；95%CI，0.39至1.29）和1981年（调整后的OR，0.36；95%CI，0.19至0.66）住院患者的死亡几率下降，但在随后至1990年的研究年份中基本保持不变。对于75岁及以上的患者，死亡几率在1984年之前下降（调整后的OR，0.42；95%CI，0.25至0.72），但在随后的研究年份（1986年、1988年和1990年）中有所增加。
虽然最近小于65岁的患者急性心肌梗死后的住院死亡风险有所下降，但老年组并未实现改善。老年患者急性心肌梗死的当前管理模式需要重新审视。
