Declining Severity of Myocardial Infarction From 1987 to 2002 The Atherosclerosis Risk in Communities (ARIC) Study
Declining Severity of Myocardial Infarction From 1987 to 2002 The Atherosclerosis Risk in Communities (ARIC) Study
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DOI：
10.1161/circulationaha.107.693879
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发表时间：
2009-02-03
期刊：
影响因子：
37.8
通讯作者：
Goff, David C., Jr.
中科院分区：
文献类型：
--
作者：
Myerson, Merle;Coady, Sean;Goff, David C., Jr.
背景--美国的冠心病死亡率一直在下降，但下降的原因尚不清楚。导致这一下降的一个因素可能是急性心肌梗死(MI)严重程度的降低。我们假设，在社区动脉粥样硬化风险(ARIC)研究中住院的急性心肌梗死患者，从1987年到2002年，心肌梗死严重程度有所下降。方法和结果-ARIC研究的社区监测部分包括跟踪4个不同社区35-74岁的住院心肌梗死或致命冠心病患者。对于突发事件、住院心肌梗死，验证出院概率样本，并根据由胸痛、心电证据和心脏生物标志物组成的算法分配心肌梗死分类。严重程度指标是从确认为确定或可能的心肌梗死的抽象医院图表中选择的。除极少数例外，心肌梗死严重程度指标显示，在1987年至2002年期间，心肌梗死严重程度显著下降。有主要心电图异常的心肌梗死患者所占比例下降，起始期ST段抬高者下降1.9%(P=0.002)，随后出现Q波者下降3.9%(P<；0.001)，任何主要Q波者下降4.5%(P<；0.001)。肌酸激酶和肌酸激酶-MB的最大值下降(分别为5.2%和7.6%；P<；0.001，P<；0.001)，但在后来的几年中，最大肌钙蛋白I值保持稳定(每年下降1.1%；P=0.66)。休克的百分比下降(5.7%/y；P<；0.001)，尽管充血性心力衰竭患者保持稳定。综合严重程度评分，心脏病死亡风险预测工具评分也下降(0.2%/年；P<；0.001)。黑人的结果与整个群体的结果相似，女性的结果也是如此。结论--ARIC社区监测的证据表明，因急性心肌梗死而住院的社区居民的急性心肌梗死的严重程度已经下降。这种严重程度的降低可能与其他因素一起导致了冠心病死亡率的下降。(发行量。2009；119：503-514。)
Background-Death rates for coronary heart disease have been declining in the United States, but the reasons for this decline are not clear. One factor that could contribute to this decline is a reduction in the severity of acute myocardial infarction (MI). We hypothesized that for those patients hospitalized in the Atherosclerosis Risk in Communities (ARIC) Study with acute incident MI, there was a decline in MI severity from 1987 to 2002.Methods and Results-The community surveillance component of the ARIC Study consisted of tracking residents 35 to 74 years of age with hospitalized MI or fatal coronary heart disease in 4 diverse communities. For incident, hospitalized MI, a probability sample of hospital discharges was validated and an MI classification was assigned according to an algorithm consisting of chest pain, ECG evidence, and cardiac biomarkers. Severity indicators were chosen from abstracted hospital charts validated as a definite or probable MI. With few exceptions, the MI severity indicators suggested a significant decline in the severity of MI during the period of 1987 to 2002. The percent of MI cases with major ECG abnormalities decreased as evidenced by a 1.9%/y ( P=0.002) decline in the proportion of those with initial ST-segment elevation, a 3.9%/y (P < 0.001) decline in those with subsequent Q-waves, and a 4.5%/y (P < 0.001) decline in those with any major Q wave. Maximum creatine kinase and creatine kinase-MB values declined (5.2% and 7.6%; P < 0.001, P < 0.001 per year, respectively), although in the later years, maximum troponin I values remained stable (1.1%/y decline; P=0.66). The percent with shock declined (5.7%/y; P < 0.001), although those with congestive heart failure remained stable. A combined severity score, the Predicting Risk of Death in Cardiac Disease Tool ( PREDICT) score, also declined (0.2%/y; P < 0.001). Results for blacks paralleled those of the entire group, as did results for women.Conclusions-Evidence from ARIC community surveillance suggests that the severity of acute MI has declined among community residents hospitalized for incident MI. This reduction in severity may have contributed, along with other factors, to the decline in death rates for coronary heart disease. (Circulation. 2009;119:503-514.)