25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study
25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study
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DOI：
10.1136/bmj.e356
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发表时间：
2012-01-25
影响因子：
105.7
通讯作者：
Sorensen, Henrik Toft
中科院分区：
文献类型：
--
作者：
Schmidt, Morten;Jacobsen, Jacob Bonde;Sorensen, Henrik Toft
目的研究丹麦急性心肌梗死首次住院治疗的25年趋势，随后的短期和长期死亡率，性别和合并症对预后的影响。设计：采用医学登记的全国人群队列研究。设置：丹麦的所有医院。受试者：1984年至2008年因心肌梗死首次住院的234 331例患者。主要结局按性别衡量心肌梗死的标准化发生率以及30天和31-365天死亡率。合并症类别被定义为正常，中度，严重，非常严重的根据Charlson合并症指数，并进行了比较的死亡率比的基础上考克斯regulation.Results的标准化发病率每10万人在25年期间下降了37%的女性（从209至131）和48%的男性（从410至213）。30天、31-365天和1年死亡率分别从1984-8年的31.4%、15.6%和42.1%下降到2004-8年的14.8%、11.1%和24.2%。在对心肌梗死时的年龄进行调整后，男性和女性的一年死亡风险相同。死亡率降低与合并症类别无关。比较2004年至2008年期间非常严重的合并症患者与正常合并症患者的死亡率比，经年龄和性别调整，为1.96（95% CI 1.83 - 2.11）30天内和3.89（3.58至4.24）在31-结论：1984年以来，因心肌梗死首次住院率和随后的短期死亡率均下降了近一半和2008所有患者的死亡率均降低，与性别和合并症无关。然而，合并症负担是短期和长期死亡率的一个强有力的预后因素，而性别不是。
Objectives To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity.Design Nationwide population based cohort study using medical registries.Setting All hospitals in Denmark.Subjects 234 331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008.Main outcome measures Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression.Results The standardised incidence rate per 100 000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days.Conclusions The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.