Goldberg R J, McCormick D, Gurwitz J H, Yarzebski J, Lessard D, Gore J M
Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
Am J Cardiol. 1998 Dec 1;82(11):1311-7. doi: 10.1016/s0002-9149(98)00633-x.
This study examines age-related differences and temporal trends in hospital and long-term survival after acute myocardial infarction (AMI) over a 2-decade-long (1975 to 1995) experience. A total of 8,070 patients with validated AMI hospitalized in all acute care hospitals in the Worcester, Massachusetts, metropolitan area (1990 census population 437,000) were studied over 10 one-year periods between 1975 and 1995. This population included 1,326 patients aged <55 years (16.4%), 1,768 patients aged 55 to 64 years (21.9%), 2,325 patients aged 65 to 74 years (28.8%), 1,880 patients aged 75 to 84 years (23.3%), and 771 patients aged > or = 85 years (9.6%). Compared with patients <55 years, patients 55 to 64 years were 2.2 times more likely to die during hospitalization for AMI, whereas patients 65 to 74, 75 to 84, and > or = 85 years were at 4.2, 7.8, and 10.2 times greater risk of dying, respectively. Similar age disparities in the risk of dying were seen when controlling for additional prognostic factors. Despite the adverse impact of increasing age on hospital survival after AMI, declining in-hospital death rates were seen in each of the age groups under study, with declining magnitude of these trends with advancing age. Among discharged hospital patients, increasing age was related to a significantly poorer long-term prognosis. Trends toward improving long-term prognosis were seen in patients discharged in the mid-1990s compared with those discharged in the mid- to late 1970s for patients aged <85 years. The present results demonstrate the marked impact of advancing age on survival after AMI. Despite the adverse impact of age on prognosis, encouraging trends in prognosis were observed in all age groups, although to a lesser extent in the oldest elderly patients. These findings emphasize the low death rates in middle-aged patients with AMI and the need for targeted secondary prevention efforts in elderly patients with AMI.
本研究调查了在长达20年（1975年至1995年）的时间段内，急性心肌梗死（AMI）后住院及长期生存方面与年龄相关的差异和时间趋势。对马萨诸塞州伍斯特市大都市区（1990年人口普查人口为43.7万）所有急症医院收治的8070例经确诊的AMI患者进行了研究，研究时间跨度为1975年至1995年期间的10个一年时间段。该人群包括1326例年龄小于55岁的患者（16.4%）、1768例年龄在55至64岁之间的患者（21.9%）、2325例年龄在65至74岁之间的患者（28.8%）、1880例年龄在75至84岁之间的患者（23.3%）以及771例年龄大于或等于85岁的患者（9.6%）。与年龄小于55岁的患者相比，年龄在55至64岁之间的患者因AMI住院期间死亡的可能性高出2.2倍，而年龄在65至74岁、75至84岁以及大于或等于85岁的患者死亡风险分别高出4.2倍、7.8倍和10.2倍。在控制其他预后因素时，也观察到了类似的年龄死亡风险差异。尽管年龄增长对AMI后住院生存有不利影响，但在所研究的每个年龄组中，住院死亡率均呈下降趋势，且随着年龄增长这种下降趋势的幅度减小。在出院患者中，年龄增长与长期预后明显较差相关。与20世纪70年代中期至后期出院的患者相比，20世纪90年代中期出院的年龄小于85岁的患者长期预后有改善趋势。目前的结果表明年龄增长对AMI后生存有显著影响。尽管年龄对预后有不利影响，但在所有年龄组中均观察到了令人鼓舞的预后趋势，不过在最年长的老年患者中程度较小。这些发现强调了中年AMI患者的低死亡率以及对老年AMI患者进行有针对性的二级预防措施的必要性。
