Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents
Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents
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DOI：
10.1016/j.atherosclerosis.2011.05.012
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发表时间：
2011-09-01
期刊：
影响因子：
5.3
通讯作者：
Brugada, Ramon
中科院分区：
文献类型：
--
作者：
Oliva, Antonio;Flores, Jose;Brugada, Ramon
背景：全球每年有120万人死于机动车事故(MVA)，这给医疗保健带来了巨大的负担。本研究的目的是明确冠心病的患病率及其在机动车事故中的可能作用。方法和结果：我们调查了2002-2006年魁北克西部地区连续的非医院猝死尸检病例，重点是MVA的受害者。严重冠状动脉疾病(CAD)被定义为心脏横截面积的75%变窄或主要心外膜冠状动脉出现急性斑块事件。在总共1260例尸检中，MVA造成了123例死亡，其中100例为男性，23例为女性。在这些病例中，约有37%的病例记录有显著的冠心病。在60岁以上的人群中，显著冠心病和缺血性心脏病的患病率分别为86.2%和19.8%。据目击者观察，40%的冠心病患者在事故发生前表现出不稳定的驾驶行为。统计分析显示，患冠心病的个体发生机动车事故的概率为9%。结论：在患有MVA的个体中，严重的CAD和急性心肌缺血的患病率很高。我们的数据表明，在一大群受冠心病影响的司机中，急性CAD可能是事故的原因这一假设。出于这些原因，可以在50岁以上的司机中进行冠心病调查，作为一种可能的预防措施和个人风险分层的决定因素。(C)2011爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Each year, 1.2 million people die worldwide as a result of motor-vehicle accidents (MVA), representing a tremendous burden to healthcare. The aim of this study was to define the prevalence of coronary disease and its possible role in motor-vehicle accidents.Methods and results: We examined consecutive cases of non-hospital sudden death autopsies in the area of West Quebec during the period of 2002-2006, and we focused on those victims of MVA. Severe coronary artery disease (CAD) was defined as a narrowing of >= 75% of a cross-sectional area or the presence of acute plaque events in major epicardial coronary arteries. From a total cohort of 1260 autopsies, MVA were responsible for 123 deaths, 100 of whom were men and 23 were women. Significant CAD was documented in approximately 37% of these cases. In individuals older than 60 years, the prevalence of significant CAD and ischemia were 86.2% and 19.8%, respectively. A percentage of 40% of the coronary patients showed erratic driving before the accident, as observed by witnesses. Statistical analysis showed that an individual affected by CAD has 9% probability of suffering a motor-vehicle accident.Conclusions: The prevalence of severe CAD and acute myocardial ischemia is very high among individuals who have suffered a MVA. Our data suggest the hypothesis that acute CAD could be the cause of accidents in a large group of the drivers affected by coronary disease. For these reasons CAD could be investigated in drivers above 50 years old, as a possible preventive measure and determinant of individual risk stratification. (C) 2011 Elsevier Ireland Ltd. All rights reserved.