UNRECOGNIZED MYOCARDIAL-INFARCTION - EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, AND THE PROGNOSTIC ROLE OF ANGINA-PECTORIS - THE REYKJAVIK STUDY
UNRECOGNIZED MYOCARDIAL-INFARCTION - EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, AND THE PROGNOSTIC ROLE OF ANGINA-PECTORIS - THE REYKJAVIK STUDY
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DOI：
10.7326/0003-4819-122-2-199501150-00003
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发表时间：
1995-01-15
影响因子：
39.2
通讯作者：
SIGFUSSON, N
中科院分区：
文献类型：
--
作者：
SIGURDSSON, E;THORGEIRSSON, G;SIGFUSSON, N
目的：评价临床诊断为不明原因心肌梗死的发病率、患病率、特点和预后。设计：前瞻性人群队列研究，随访4~20年。地点：冰岛心脏协会预防诊所。参与者：居住在雷克雅未克地区的9141名男性，出生于1907年至1934年。测量：根据住院记录、Rose胸痛问卷、标准化12导联心电图以及病史和体检，将患者首次就诊时划分为不同类型的冠心病。确定不明原因心肌梗死的发生率和患病率，测量存活率，并根据死亡证明和尸检记录确定死亡原因。结果：患病率受年龄的影响很大。在最年轻的年龄段几乎检测不到，在75岁至79岁的年龄段增加到5%以上。发病率在40岁以前几乎为零，到60岁时急剧增加到每年每10万人300多例，65岁以后随着年龄的增长而下降。10年和15年的生存概率分别为51%和45%，与公认的心肌梗死患者相似。未确诊的男性患者中有三分之一有心绞痛病史(P<；0.001)，已确诊心肌梗死患者中有58%的患者有心绞痛史。心绞痛对冠心病死亡率的影响前者大于后者。未识别心肌梗死的风险比为4.6无心绞痛(95%CI，2.4~8.6)和16.9有心绞痛(CI，9.4~30.3)，可识别心肌梗死的风险比为6.3无心绞痛(CI，3.7~10.6)和8.5心绞痛(CI，5.8~12.6)。确诊和未确诊心肌梗死患者的预后和危险因素特征相似。尽管那些未被识别的心肌梗死患者比被识别的心肌梗死患者更不容易有心绞痛的病史，但这些患者的心绞痛通常与缺血性心电改变和预后不良有关，这表明存在严重的冠心病。
Objective: To evaluate the incidence, prevalence, characteristics, and prognosis associated with clinically unrecognized myocardial infarction as diagnosed by electrocardiographic changes.Design: Prospective, population-based cohort study with 4- to 20-year follow-up.Setting: Icelandic Heart Association Preventive Clinic.Participants: 9141 men residing in the Reykjavik area who were born between 1907 and 1934.Measurements: Patients were assigned to categories of coronary heart disease at first visit on the basis of hospital records, Rose chest pain questionnaire, standardized 12-lead electrocardiogram, and history and physical examination. Incidence and prevalence of unrecognized myocardial infarction were determined, survival was measured, and causes of death were determined from death certificates and autopsy records.Results: Prevalence was strongly influenced by age. Nearly undetectable in the youngest age group, it increased to more than 5% in the group aged 75 to 79 years. Incidence was almost zero up to age 40, then increased steeply to more than 300 cases per year per 100 000 persons at age 60, and decreased with age after age 65. Ten- and 15-year survival probabilities were 51% and 45%, respectively, and were similar to those for patients with recognized myocardial infarction. One third of men with unrecognized and 58% of men with recognized myocardial infarction had a history of angina pectoris (P < 0.001). Angina pectoris had a greater effect on coronary heart disease mortality in the former group than in the latter. The risk ratio for unrecognized myocardial infarction was 4.6 without angina (95% CI, 2.4 to 8.6) and 16.9 with angina (CI, 9.4 to 30.3); the risk ratio for recognized myocardial infarction was 6.3 without angina (CI, 3.7 to 10.6) and 8.5 with angina (CI, 5.8 to 12.6).Conclusion: At least one third of all myocardial infarctions were unrecognized. Prognosis and risk factor profiles for patients with recognized and unrecognized myocardial infarction were similar. Although those with unrecognized myocardial infarction were less likely than those with recognized myocardial infarction to have a history of angina pectoris, angina in these cases was usually associated with ischemic electrocardiographic changes and a poor prognosis, suggesting severe coronary heart disease.