Myocardial Infarction in the Population

描述（由申请人提供）： 通过我们的伴随基金R01 HL 59205测量的冠心病（CHD）趋势记录了老年人CHD死亡率、MI发病率和MI后生存率的长期不利趋势。这些趋势在所有测量指标中一致，证明了CHD负担向老年人群转移，并强调了包括所有年龄以捕获与年龄相关的结局差异以及获得门诊数据以全面表征流行CHD负担的重要性。为了深入了解CHD趋势的影响和决定因素，需要对MI后结局（包括复发性缺血性事件和心力衰竭）进行全面分析，CHD趋势对老龄化人群具有重要意义。事实上，虽然随着时间的推移而下降，但心力衰竭在MI事件后仍然频繁发生，其决定因素尚不清楚。特别是，几乎没有关于左心室（LV）功能障碍和LV重构（定义为LV几何结构随时间的变化）发生率的基于人群的数据，这是心力衰竭的已知前兆，也没有关于年龄对LV重构的独立作用的数据。 这些数据的获取将受到以下因素的限制：1）老年组，包括最高风险和人口增长最快的部分，不包括在几个监测计划。2)用于临床诊断MI的生物标志物的最新变化将在通过被动监测测量的趋势中引入不连续性，并修改标记为MI的疾病谱。3)基于医院的监测没有捕捉门诊结果，这是目前从住院治疗转移的疾病流行的重要组成部分。 马约诊所超声心动图实验室和罗切斯特流行病学项目优化了马约诊所以患者为导向的特殊研究环境，这是解决这些问题的独特资源，从而为初级研究人员提供了以患者为导向的丰富研究经验。因此，通过我们的同伴补助金实施的方法的基础上，结合新的和前瞻性的方法，这个K24补助金的目标是开发一个程序，以指导初级研究人员在以患者为导向的研究。本申请的科学目的是检查：1）使用前瞻性采集的数据，实施基于肌钙蛋白的诊断算法对住院MI发病率和CHD死亡率的影响。2)MI事件后心脏手术的严重程度、自然病史和使用趋势以及年龄对这些趋势的影响。3)使用前瞻性采集的数据，超声心动图确定的LV几何结构和功能参数的患病率和变化，以确定MI后LV收缩功能障碍的患病率和MI后LV重构的发生率。为了优化这些系列研究的培训潜力和学员的学习经验，在此修订的应用程序中详细列出了一个强大的指导计划。

DESCRIPTION (provided by applicant): Coronary heart disease (CHD) trends measured via our companion grant R01 HL 59205 document adverse secular trends among the elderly with regards to CHD mortality, MI incidence and post-MI survival. These trends, consistent across all indicators measured, document a shift in the burden of CHD towards older segments of the population and underscore the importance of including all ages to capture age-related differences in outcome and of the access to outpatient data to comprehensively characterize the burden of prevalent CHD. To provide insight into the impact and determinants of CHD trends, which have substantial implications in an aging population, a comprehensive analysis of post-MI outcomes including recurrent ischemic events and heart failure is needed. Indeed, although declining over time, heart failure remains frequent after incident MI and its determinants are not well known. In particular, there is virtually no population-based data on the occurrence of left ventricular (LV) dysfunction and LV remodeling (defined by changes over time in LV geometry), a known precursor of heart failure and on the independent role of age on LV remodeling. The acquisition of such data will be limited by the following factors: 1) Older age groups, comprising the highest risk and fastest growing segment of the population, are not included in several surveillance programs. 2) Recent changes in the bio-marker used to diagnose MI clinically will introduce discontinuity in the trends measured through passive surveillance and modify the spectrum of disease labeled as MI. 3) Hospital-based surveillance does not capture outpatient outcomes, an important component of disease prevalence with current shifts away from in-patient care. The exceptional patient-oriented research environment at the Mayo Clinic optimized by the Mayo Clinic Echocardiographic Laboratory and the Rochester Epidemiology Project is a unique resource to address these questions thereby providing a rich experience in patient oriented research to junior investigators. Thus, building on methods implemented through our companion grant, in conjunction with novel and prospective approaches, the objective of this K24 grant is to develop a program to mentor junior investigators in patient-oriented research. The scientific aims of this application are to examine: 1) Using prospectively acquired data, the impact of the implementation of Troponin-based diagnostic algorithms on the incidence of hospitalized MI and on CHD mortality. 2) The trends in the severity, natural history and utilization of cardiac procedures after incident MI and the impact of age on such trends. 3) Using prospectively acquired data, the prevalence and change in echocardiographically determined parameters of LV geometry and function in order to determine the prevalence of LV systolic dysfunction after MI, and the incidence of post-MI LV remodeling. To optimize the training potential of these series of studies and the learning experience of mentees a strong mentoring plan is outlined in details in this revised application.