Trends in treatment and outcomes for acute myocardial infarction: 1975-1995
Trends in treatment and outcomes for acute myocardial infarction: 1975-1995
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DOI：
10.1016/s0002-9343(00)00712-9
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发表时间：
2001-02-15
影响因子：
5.9
通讯作者：
McClellan, M
中科院分区：
文献类型：
--
作者：
Heidenreich, PA;McClellan, M
目得：回顾过去20 years.MATERIAL AND METHODS：通过MEDLINE检索和研究文献回顾，确定了急性心肌梗死患者的治疗和生存趋势。从医疗保健融资管理局获得了其他数据，包括来自医疗保险索赔文件的数据（A部分）。30天死亡率的计算使用医疗保险数据和全国医院出院调查的病死率。使用已发表的荟萃分析确定治疗效果。如果已发表的研究报告在人群水平上使用急性心肌梗死治疗，则纳入研究。趋势的人口统计学特征的患者以及梗死的特点，药物使用，和血运重建recorded.RESULTS：使用急性治疗，是已知的，以提高心肌梗死患者的生存率显着增加，在过去的20年中，估计交配9.6%的减少（从27.0%到17.4%），在30天的死亡率。在调整治疗之间的潜在相互作用后，阿司匹林、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂和再灌注的使用增加可以解释1975年至1995年30天年龄和性别调整死亡率下降的71%。最有效的治疗方法是阿司匹林，其30天死亡率下降了34%，其次是溶栓（17%），直接血管成形术（10%），β受体阻滞剂（7%）和ACE抑制剂（3%）。如果其他治疗（如肝素或非主要血管成形术），其对死亡率的影响是不太确定的，包括，高达90%的30天死亡率的下降可以解释的变化，在treatment.CONCLUSIONS：在过去20年中，心肌梗死早期死亡率下降的主要原因似乎是增加使用有效的治疗。（C）2001年由Excerpta Medica，Inc.
PURPOSE: To review the trends in treatment and survival for patients with acute myocardial infarction over the last 20 years.MATERIAL AND METHODS: Studies were identified through MEDLINE searches and review of study bibliographies. Additional data were obtained from the Health Care Financing Administration including data from Medicare claims files (part A). Thirty-day mortality rates were calculated using Medicare data and case fatality rates from the National Hospital Discharge Survey. Published meta-analyses were used to determine treatment effects. Published studies were included if they reported the use of therapies for acute myocardial infarction at a population level. Trends in the demographic characteristics of the patients as well as infarct characteristics, medication use, and revascularization were recorded.RESULTS: The use of acute treatments that are known to improve survival among patients with myocardial infarction has increased markedly during the last 20 years, leading to an estimated mated 9.6% reduction (from 27.0% to 17.4%) in 30-day mortality. After adjusting for potential interactions between therapies, the increase in use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and reperfusion can explain 71% of the decrease in the 30-day age- and sex-adjusted mortality rate from 1975 to 1995. The greatest effect of a given therapy was that of aspirin, which accounted for 34% of the decrease in 30-day mortality, followed by thrombolysis (17%), primary angioplasty (10%), beta-blockers (7%), and ACE inhibitors (3%). If other treatments (such as heparin or nonprimary angioplasty), whose effects on mortality are less certain, are included, up to 90% of the decrease in 30-day mortality can be explained by changes in treatment.CONCLUSIONS: The primary reason for the decrease in early mortality from myocardial infarction during the last 20 years appears to be increased use of effective treatments. (C)2001 by Excerpta Medica, Inc.