Incidence of heart failure after myocardial infarction: Is it changing over time?
Incidence of heart failure after myocardial infarction: Is it changing over time?
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DOI：
10.1093/aje/kwg078
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发表时间：
2003-06-15
影响因子：
5
通讯作者：
Roger, VL
中科院分区：
文献类型：
--
作者：
Hellermann, JP;Goraya, TY;Roger, VL
心肌梗死（MI）后生存率的提高可能导致心肌梗死幸存者对美国心力衰竭流行的贡献。相反，由于心肌梗死的严重程度随着时间的推移而下降，心肌梗死后心力衰竭的下降也可能是预期的。本研究在地理上确定的心肌梗死发生率队列中验证了心肌梗死后心力衰竭发生率随时间下降的假设。1979年至1994年间，明尼苏达州奥姆斯特德县有1537例无心力衰竭病史的心肌梗死患者住院。Framingham心脏研究标准用于确定住院和门诊心力衰竭的发生率，平均随访时间为7.6年（标准差为5.5）。总体而言，36%的患者出现心力衰竭。调整心肌梗死后心力衰竭相关因素（年龄、高血压、吸烟和生物标志物）后，心力衰竭发生率每年下降2%（相对危险度= 0.98,95%可信区间：0.96,0.99;p = 0.01）。1994年与1979年相比，心肌梗死患者发生心力衰竭的相对风险为0.72(95%可信区间：0.55,0.93)，表明心力衰竭发生率降低了28%。心肌梗死后24小时内进行再灌注治疗与心肌梗死后心力衰竭的风险降低相关，并且是心力衰竭时间下降的主要原因。这表明心肌梗死后生存率的提高不太可能是心力衰竭流行的主要原因。
Improved survival after myocardial infarction (MI) could result in MI survivors' contributing to the US heart failure epidemic. Conversely, since the severity of MI is declining over time, a decline in post-MI heart failure might also be anticipated. This study tested the hypothesis that the incidence of post-MI heart failure was declining over time in a geographically defined MI incidence cohort. Between 1979 and 1994, 1,537 patients with incident MI and no prior history of heart failure were hospitalized in Olmsted County, Minnesota. Framingham Heart Study criteria were used to ascertain the incidence of inpatient and outpatient heart failure over a mean follow-up period of 7.6 years (standard deviation 5.5). Overall, 36% of patients experienced heart failure. After adjustment for factors related to post-MI heart failure (age, hypertension, smoking, and biomarkers), the incidence of heart failure declined by 2% per year (relative risk = 0.98, 95% confidence interval: 0.96, 0.99; p = 0.01). The relative risk of developing heart failure among persons with MIs occurring in 1994 versus 1979 was 0.72 (95% confidence interval: 0.55, 0.93), indicating a 28% reduction in the incidence of heart failure. Administration of reperfusion therapy within 24 hours after MI was associated with lower risk of post-MI heart failure and accounted for most of the temporal decline in heart failure. This suggests that improved survival after MI is unlikely to be a major contributor to the heart failure epidemic.