Case definitions for acute coronary heart disease in epidemiology and clinical research studies - A statement from the AHA council on epidemiology and prevention; AHA Statistics Committee; World Heart Federation Council on epidemiology and prevention; the European Society of Cardiology working group on epidemiology and prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute
Case definitions for acute coronary heart disease in epidemiology and clinical research studies - A statement from the AHA council on epidemiology and prevention; AHA Statistics Committee; World Heart Federation Council on epidemiology and prevention; the European Society of Cardiology working group on epidemiology and prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute
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DOI：
10.1161/01.cir.0000100560.46946.ea
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发表时间：
2003-11-18
期刊：
影响因子：
37.8
通讯作者：
Tunstall-Pedoe, H
中科院分区：
文献类型：
--
作者：
Luepker, RV;Apple, FS;Tunstall-Pedoe, H
冠心病（CHD）的流行始于20世纪世纪的大多数工业化国家，其中CHD是成人死亡的主要原因。1发展中国家也开始出现同样的流行病。关于CHD人群发病率、患病率和病死率的可靠信息对于了解、治疗和控制该流行病至关重要，但通常无法获得。CHD病例的一致和通用定义允许确定人群内和人群间的比率和比较。这些病例定义对于流行病学研究和其他研究（如临床试验、质量保证和医疗成本的经济分析）至关重要。标准化的必要性是明确的，本声明建议更新定义。流行病学研究和急性CHD临床试验的病例定义基于世界卫生组织（WHO）（1959）和美国心脏协会（1964）报告，随后是WHO欧洲AMI登记标准。2，3心肌梗死（MI）是基于心脏症状、ECG变化和/或生物标志物升高。这一基本系统得到广泛使用，但解释不清，导致研究之间和研究内部缺乏可比性。CHD的进一步规范和工作定义来自Fractionary研究。[4] 1979年，在与国际心脏病学会和联合会的联合报告中修订了WHO标准。5最近，世卫组织MONICA研究6和其他监测和干预研究，如美国的脂质研究诊所7，进一步修改了CHD病例的定义。这些变化通常是基于一个更大的规格，以原来的世界卫生组织的定义，以允许在不同的settings.Advancing诊断技术，治疗干预措施，并在近年来不断变化的疾病表现的应用迫使急性冠心病的病例定义的重新评估。新的生物标志物，心肌肌钙蛋白和肌酸激酶（CK）-MB质量提供的信息，是更敏感和/或具体的检测，即使是轻微的心肌细胞损伤。8新的成像方法，如磁共振成像和放射性同位素成像，虽然今天还没有广泛使用，但将增加诊断工具。这些进展最近在欧洲心脏病学会/美国心脏病学会关于心肌梗死重新定义的联合研讨会上进行了审查。9该报告于2000年发表，为面临不断变化的诊断测试和新信息的临床医生提供了方向。最近的另一份报告将建议扩展到临床试验。[10]然而，它们未能为流行病学家提供方向，因为他们面临着在回顾性监测的基础上评估和解释事件发生率趋势的问题。CHD的表现形式也在发生变化。无论是由于疾病严重程度的变化、诊断测试的改进、诊断的专业意识的提高、公众对CHD症状的认识的提高，还是医院的保险报销，
An epidemic of coronary heart disease (CHD) began during the 20th century in most industrialized countries, where CHD is a leading cause of mortality among adults. 1 Developing countries show the beginnings of the same epidemic. Reliable information on population incidence, prevalence, and case-fatality rates of CHD is essential to understanding, treating, and controlling the epidemic but is generally unavailable. Consistent and universal definitions of cases of CHD allow the determination of rates and comparisons within and between populations. These case definitions are essential to epidemiological studies and other research, such as clinical trials, quality assurance, and economic analysis of healthcare costs. The need for standardization is clear, and this statement recommends updated definitions. Definitions of cases for epidemiology studies and clinical trials in acute CHD rest on World Health Organization (WHO)(1959) and American Heart Association (1964) reports, followed by the WHO European AMI Registry criteria. 2, 3 Myocardial infarction (MI) is based on cardiac symptoms, ECG changes, and/or elevation in biomarkers. This basic system has been widely used but variably interpreted, resulting in a lack of comparability among and within studies. Further specification and working definitions of CHD come from the Framingham Study. 4 The WHO criteria were revised in a joint report with the International Society and Federation of Cardiology in 1979. 5 More recently, the WHO MONICA Study6 and other surveillance and intervention studies, such as the Lipid Research Clinics in the United States, 7 have modified further the definition of CHD cases. These changes are usually based on a greater specification to the original WHO definition to allow for application in different settings.Advancing diagnostic technology, therapeutic interventions, and changing disease presentation in recent years forces a reevaluation of case definitions for acute CHD. New biomarkers, cardiac troponins, and creatine kinase (CK)-MB mass provide information that is more sensitive and/or specific in detecting even minor myocardial cell damage. 8 New imaging methods, such as MRI and radioisotope imaging, although not widely available today, will add to the diagnostic tools. These developments were recently reviewed in a Joint European Society of Cardiology/American College of Cardiology Workshop on the Redefinition of Myocardial Infarction. 9 That report, published in 2000, provided direction for clinicians faced with changing diagnostic testing and new information. Another recent report extends advice to clinical trials. 10 However, they fall short of providing direction for epidemiologists faced with evaluating and interpreting trends in event rates on the basis of retrospective surveillance. Patterns of CHD presentation are also changing. Whether because of changes in disease severity, improved diagnostic testing, increased professional awareness of the diagnosis, heightened public awareness of CHD symptoms, or insurance reimbursement to hospitals, cases of CHD in hospitalized