Myocardial Infarction in the Population

描述(由申请人提供)： 通过我们的伙伴赠款R01 HL 59205测量的冠心病趋势表明，老年人在冠心病死亡率、心肌梗死发生率和心肌梗死后存活率方面存在不利的长期趋势。这些趋势在所有衡量的指标中都是一致的，记录了冠心病负担向人口中老年群体的转移，并强调了纳入所有年龄以捕捉与年龄相关的结局差异的重要性，以及获得门诊数据以全面描述普遍存在的冠心病负担的重要性。为了洞察冠心病趋势的影响和决定因素，这在人口老龄化中具有重要意义，需要对心肌梗死后的结果进行全面分析，包括反复发生的缺血事件和心力衰竭。事实上，尽管心力衰竭随着时间的推移而下降，但心力衰竭在急性心肌梗死事件后仍然很常见，其决定因素还不是很清楚。特别是，几乎没有基于人群的数据关于左心室(LV)功能障碍和LV重塑(由左室几何形状随时间的变化定义)的发生，这是已知的心力衰竭的先兆，以及年龄在LV重塑中的独立作用。 此类数据的获取将受到以下因素的限制：1)构成人口中风险最高和增长最快的部分的老年群体不包括在几个监测项目中。2)用于临床诊断心肌梗死的生物标志物的最新变化将使被动监测测量的趋势不连续，并修改标记为心肌梗死的疾病谱。3)基于医院的监测不包括门诊结果，这是目前从住院护理转向疾病流行的一个重要组成部分。 梅奥诊所由梅奥诊所超声心动图实验室和罗切斯特流行病学项目优化的独特的以患者为中心的研究环境是解决这些问题的独特资源，从而为初级研究人员提供了丰富的以患者为中心的研究经验。因此，在通过我们的伙伴基金实施的方法的基础上，结合新的和前瞻性的方法，K24基金的目标是开发一个项目，指导以患者为导向的研究中的初级研究人员。这项应用的科学目的是检验：1)使用预期获得的数据，实施基于肌钙蛋白的诊断算法对住院心肌梗死发生率和冠心病死亡率的影响。2)急性心肌梗死事件后心脏手术的严重程度、自然病史和使用情况的趋势，以及年龄对这些趋势的影响。3)使用前瞻性获得的数据，超声心动图确定的左心室几何和功能参数的患病率和变化，以确定MI后左室收缩功能障碍的患病率，以及MI后左室重构的发生率。为了优化这些系列研究的培训潜力和受训者的学习经验，在这份修订后的申请中详细概述了一个强有力的指导计划。

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.