Impact of Comorbidities on In-Hospital Mortality From Acute Myocardial Infarction, 2003-2009
Impact of Comorbidities on In-Hospital Mortality From Acute Myocardial Infarction, 2003-2009
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DOI：
10.1016/j.recesp.2011.07.010
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发表时间：
2011-12-01
影响因子：
5.9
通讯作者：
Sanchez, Gabriel
中科院分区：
文献类型：
--
作者：
Gili, Miguel;Sala, Jose;Sanchez, Gabriel
前言和目的：近年来，急性心肌梗死的治疗发生了显著变化。本研究的目的是分析2003-2009年期间住院死亡率的趋势，并探讨合并症指数的变化如何影响急性心肌梗死死亡率预测模型使用最小基础dataset.Methods：在研究期间，5275例急性心肌梗死。按年龄和性别计算死亡率，并在每位患者入院时获得Charlson和Elixhauser合并症指数评分。趋势进行了分析，并研究其有效性。多变量模型预测的死亡率进行了推导和compared.Results：平均年龄和合并症在2003年至2009年期间，所有患者的增加。尽管有这些趋势，急性心肌梗死死亡率下降。当采用“入院时在场”标准时，科摩罗指数仍然有效。多变量预测模型包括年龄、性别、药物治疗、冠状动脉血运重建和合并症指数或特定合并症。具有特定合并症的模型显示出最佳的预测能力。所有模型均发现年龄和合并症增加死亡风险，冠状动脉血运重建和抗凝剂、纤溶剂和血小板抗聚集剂治疗是保护因素。尽管急性心肌梗死患者的平均年龄和合并症的数量逐年增加，但急性心肌梗死死亡率下降，可能是因为更频繁的再灌注和血管重建治疗以及更好的医疗。(C)2011年西班牙心脏病学会。出版社：Elsevier Espana，S.L. All rights reserved.
Introduction and objectives: Treatment of acute myocardial infarction has changed notably in recent years. The objective of this study was to analyze trends in in-hospital mortality during the period 2003-2009 and to examine how changes in comorbidity indices affected mortality prediction models for acute myocardial infarction using the minimum basic data set.Methods: During the study period, 5275 cases of acute myocardial infarction were admitted. Mortality rates were calculated by age and sex and Charlson and Elixhauser comorbidity index scores were obtained on admission for every patient. Trends were analyzed and their validity studied. Multivariate models predictive of mortality were derived and compared.Results: Mean age and comorbidities increased in all patients over the period 2003-2009. In spite of these trends, acute myocardial infarction mortality decreased. Comorbidity indices remained valid when the criterion "present on admission" was applied. Multivariate predictive models included age, sex, medical treatment, coronary revascularization and a comorbidity index or specific comorbidities. The model with specific comorbidities showed the best predictive ability. All models found that age and comorbidities increased the risk of death, and that coronary revascularization and treatment with anticoagulants, fibrinolytics, and platelet antiaggregants were protective factors.Conclusions: Despite the fact that the mean age and number of comorbidities in acute myocardial infarction patients has increased year over year, acute myocardial infarction mortality has decreased, probably because of more frequent reperfusion and revascularization therapy and better medical treatment. (C) 2011 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L. All rights reserved.