Clinical epidemiology of acute myocardial infarction
Clinical epidemiology of acute myocardial infarction
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DOI：
10.1016/s0002-8703(99)70320-0
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发表时间：
1999-08-01
影响因子：
4.8
通讯作者：
Tavazzi, L
中科院分区：
文献类型：
--
作者：
Tavazzi, L
在美国，到本世纪中叶，心血管疾病占所有死亡人数的一半以上。在本世纪下半叶，所有原因的年龄调整死亡率下降的85%可以归因于心血管疾病和中风死亡的下降。缺血性心脏病(IHD)死亡率的急剧下降，约有一半可以通过一级和二级预防来解释，另一半可以通过治疗改进来解释。急性心肌梗死(AMI)治疗方案的流行病学表明，溶栓治疗、阿司匹林、β-受体阻滞剂的使用大幅增加，在一些国家还包括冠状动脉成形术。几项溶栓试验的长期结果表明，早期的益处一直持续到急性心肌梗死后10年。然而，大约一半的急性心肌梗死患者入院太晚，无法充分受益于溶栓治疗，而符合条件的患者中有四分之一没有接受任何形式的再通。一些人主张将直接血管成形术作为急性心肌梗死的首选治疗方法。目前的结果不足以令人信服，不足以促使卫生系统进行极其复杂和昂贵的重组，允许所有或大多数急性心肌梗死患者立即进行冠状动脉造影术。然而，在先前闭塞的部位植入冠状动脉支架似乎可以改善冠状动脉血运重建术的即刻和中期结果。大约一半的急性心肌梗死幸存者在指标事件发生后1年内再住院，而梗死后死亡率仍然非常高。在急性心肌梗死后，在没有证据表明其疗效的对照试验中，已经引入了预后和治疗程序。需要进行结果研究来标准化有效的急性心肌梗死后政策。此外，需要新的策略来降低急性缺血事件的发生率和死亡率。一些新的IHD候选危险因素正在出现；它们与内皮功能障碍、血栓形成状态和炎症状态有关。人们希望，心血管疾病的分子手段、分子遗传学和转基因技术的进展将有助于更好地理解和更有效地治疗策略，以预防和控制IHD。
In the United States by mid-century, cardiovascular disease accounted for more than half of all deaths. In the second half of this century, 85% of reduction in age-adjusted mortality rates from all causes can be ascribed to the decline in death from cardiovascular disease and stroke. Approximately half of such dramatic decline in mortality rates from ischemic heart disease (IHD) can be explained by primary and secondary prevention and half by therapeutic improvements.Epidemiology of therapeutic regimens in acute myocardial infarction (AMI) indicates substantial increases in the use of thrombolytic therapy, aspirin, beta-blockers and, in some countries, coronary angioplasty. The long-term results of several thrombolytic trials have shown the persistence of early benefit until 10 years after AMI. However, approximately half of the patients with AMI are admitted to the hospital too late to fully benefit from thrombolytic therapy, and one Fourth of eligible patients do not receive any form of reperfusion. Primary angioplasty is advocated by some as the treatment of choice in AMI. The present results are not convincing enough to induce the enormously complex and costly reorganization of the health system, allowing the immediate access to coronary angiography For all or most patients with AMI. However, stenting the infarct coronary artery at the site of previous occlusion appears to improve the immediate and medium-term results of coronary revascularization procedures.Approximately half of the AMI survivors are rehospitalized within 1 year after the index event, and postinfarction mortality rate remains exceedingly high. After AMI, prognostic and therapeutic procedures have been introduced in the absence of evidence from controlled trials of their effectiveness profile. Outcome research is needed to standardize effective post-AMI policies. Moreover, new strategies are needed to reduce the incidence and mortality rates of acute ischemic events. A number of new candidate risk Factors for IHD are emerging; they ore associated with endothelial dysfunction, thrombogenic state, and inflammatory state. It is hoped that advances in molecular approach to cardiovascular disease, molecular genetics and transgenic techniques will allow better understanding and more effective therapeutic strategies to prevent and control IHD.