Coronary heart disease death and sudden cardiac death: A 20-year population-based study
Coronary heart disease death and sudden cardiac death: A 20-year population-based study
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DOI：
10.1093/aje/kwg057
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发表时间：
2003-05-01
影响因子：
5
通讯作者：
Roger, VL
中科院分区：
文献类型：
--
作者：
Goraya, TY;Jacobsen, SJ;Roger, VL
作为心源性猝死（SCD）的替代物，院外冠心病（CHD）死亡的趋势对于理解CHD死亡率的下降非常重要。对于院外冠心病死亡，没有事先诊断冠心病，意外SCD的定义知之甚少。作者分析了20年（1979-1998）期间CHD死亡和意外SCD的长期趋势，以检查既往CHD和SCD之间的相关性，并检验住院死亡率比SCD下降更多的假设。CHD死亡率的年下降率为5.3%，院内死亡和1.8%，院外死亡（p = 0.001）。在所有SCD中，非预期SCD的比例为49%。非预期SCD和SCD伴既往CHD的死亡率均随时间下降，但非预期SCD的下降速度慢于SCD伴既往CHD（p = 0.001）。SCD患者既往CHD的相对几率高于对照组，但相关性的程度略有下降。因此，在过去的20年中，住院CHD死亡率的下降幅度大于SCD。由于大约一半的SCD是意外的，并且这些死亡率随着时间的推移下降幅度低于既往患有CHD的SCD死亡率，因此一级预防在维持CHD死亡率下降方面变得越来越重要。
Trends in out-of-hospital coronary heart disease (CHD) death, a surrogate for sudden cardiac death (SCD), are important for understanding the decline in CHD mortality. Little is known about out-of-hospital CHD death without prior CHD diagnosis, the definition of unexpected SCD. The authors analyzed secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998) to examine the association between prior CHD and SCD and to test the hypothesis that in-hospital deaths declined more than SCDs. The yearly decline in CHD mortality rates was 5.3% for in-hospital deaths and 1.8% for out-of-hospital deaths (p = 0.001). Among all SCDs, the proportion of unexpected SCD was 49%. Mortality rates for both unexpected SCD and SCD with prior CHD declined over time, but unexpected SCD declined at a slower rate than SCD with prior CHD (p = 0.001). The relative odds of prior CHD were higher among persons with SCD than among controls, but there was a modest decline in the magnitude of the association. Thus, during the past 20 years, the decline was greater for in-hospital CHD deaths than for SCDs. Since approximately half of the SCDs were unexpected and rates of these deaths declined less over time than rates of SCD with prior CHD, primary prevention is becoming increasingly more important in sustaining the decline in CHD mortality.