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500例急性心肌梗塞患者的流行病学分析

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中华流行病学杂志 1992年第3期13卷 182-183页

作者：丁秀兰杨秀菊杨玉斌楼滨城北京医科大学人民医院急诊科　100044

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221例急性心肌梗塞患者的流行病学分析

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中华流行病学杂志 1987年第3期8卷 162-164页

作者：滕静坤鞍山市中心医院

本文分析了六年来我院收治的221例急性心肌梗塞患者，于寒冷季节及气候变化时易于发病，部分患者发病前有劳累，情绪激动及饮酒的诱因。讨论了心梗发病机制及与诱因之间的关系。心梗患者多半有冠心病常见的易患因素，如高血压病，高脂... 详细信息

本文分析了六年来我院收治的221例急性心肌梗塞患者，于寒冷季节及气候变化时易于发病，部分患者发病前有劳累，情绪激动及饮酒的诱因。讨论了心梗发病机制及与诱因之间的关系。心梗患者多半有冠心病常见的易患因素，如高血压病，高脂血症与吸烟史。提示避免发病诱因与治疗易患因素的重要性。急性心梗病前一半以上有心绞痛史。应予及时治疗，以减少发生心梗的比率。心梗中部分病人无心前区痛或疼痛轻微，在诊断时应提高警惕性。

关键词：心肌梗死/流行病学

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Important factors for the 10-year mortality rate in patients with acute chest pain or other symptoms consistent with acute myocardial infarction with particular emphasis on the influence of age

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AMERICAN HEART JOURNAL 2001年第4期142卷 624-632页

作者： Herlitz, J Karlson, BW Lindqvist, J Sjölin, M Sahlgrens Univ Hosp Div Cardiol S-41345 Gothenburg Sweden

Objective Our purpose was to describe the mortality rate and mode of death over 10 years and factors associated with death among patients admitted to the emergency department with acute chest pain or other symptoms consistent with acute myocardial infarction (AMI). Methods All patients who come to the emergency department of Sahlgrenska University Hospital in Goteborg, Sweden, with acute chest pain or other symptoms consistent with AMI during a 21-month period were studied. Results In all, 5362 patients were registered, for whom information on 10-year mortality was available in 5158 (96.2%). In all, there were 2126 deaths (41.2%). Fifty-two percent of patients were less than or equal to 65 years old. Independent predictors of death registered on admission to hospital during the subsequent 10 years were age (relative risk 1.08, 95% Cl 1.07-1.09), male sex (1.38, 1.25-1.52), initial degree of suspicion of AMI (1.13, 1.06-1.19), a pathologic initial electrocardiogram (1.76, 1.56-1.98), symptoms of congestive heart failure (1.66, 1.39-1.98), "other" nonspecific symptoms (1.22, 1.07-1.39), a history of diabetes mellitus (1.65, 1.44-1.88), a history of congestive heart failure (1.42, 1.26-1.60), a history of previous myocardial infarction (1.26, 1.12-1.40), and a history of hypertension (1.14, 1.03-1.26). For all these predictors there was a strong interaction with age, thus a much more marked influence on outcome among patients less than or equal to 65 years old than among patients > 65 years old. When the above risk indicators were simultaneously considered, development of AMI during the first 3 days after hospital admission was still an independent predictor of death (1.63, 1.43-1.86). Conclusion For patients admitted to the emergency department with acute chest pain or other symptoms consistent with AMI, several predictors based on clinical history and clinical presentation are related to the 10-year prognosis. They are more strongly associated with outcome among pati

关键词：急性病年龄因素死亡原因胸痛/诊断胸痛/流行病学胸痛/死亡率脑电描记术/统计学和数值数据急诊室医院/统计学和数值数据住院/统计学和数值数据高血压/诊断高血压/流行病学心肌梗死/诊断心肌梗死/流行病学心肌梗死/死亡率预后危险性别因素瑞典/流行病学老年人女(雌)性人类男(雄)性中年人

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INCIDENCE AND PRESENTATION OF MYOCARDIAL-INFARCTION IN NORTH-KARELIA FINLAND

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ACTA MEDICA SCANDINAVICA 1975年第3期197卷 211-216页

作者： PUSKA, P MUSTANIEMI, H UNIV KUOPIO COORDINATING CTR N KARELIA PROJECT KUOPIO FINLAND

AbstractA myocardial infarction (MI) register was started on May 1, 1972 in the county of North Karelia in Eastern Finland as a part of the North Karelia project. Information about all cases with a suspected acute MI among the North Karelian population are collected by the register. The principles of the register follow the recommendations of the WHO expert working group. Altogether 713 cases were registered between May 1, and Dec. 31, 1972. The distribution of them into diagnostic categories was: “definite” 57%, “possible” 30%, “no acute MI” 8% and “insufficient information” 5%. Patients with no acute MI have been excluded in the results. About 47% of the male patients below 65 years had a history of previous MI. Most of the patients in the group had been heavy cigarette smokers, eating mainly butter as the fat in their diet. Overweight was rare among the male patients but not among the females. During the years preceding the attack, most of the patients had visited a physician and a pathological ECG had been recorded. The average time delay before hospital treatment was internationally relatively short. The 4‐week fatality rate among patients below 65 years was 37% for males and 35% for females. These rates were slightly lower than those in the register material in Helsinki. The annual incidence rate per thousand for the age group 30–64 in North Karelia was 13.8 among males and 2.6 among females. The incidence rate increased continuously with age among males, among females it increased markedly only after the age of 60. The risk ratio between North Karelia and Helsinki for the age standardized incidence rates of males in the age group 30–64 was 1.38, and for respective mortality rates 1.21. Within North Karelia the highest incidence rate for males aged 30–64 was recorded in the rural area of Ilomantsi

关键词：年龄因素芬兰心肌梗死/流行病学心肌梗死/死亡率预后登记性别因素成年人人类中年人

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Underutilization of reperfusion therapy in eligible African Americans with acute myocardial infarction: Role of presentation and evaluation characteristics

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AMERICAN HEART JOURNAL 2001年第4期142卷 604-610页

作者： Manhapra, A Canto, JG Barron, HV Malmgren, JA Taylor, H Rogers, WJ Weaver, WD Every, NR Borzak, S Henry Ford Heart & Vasc Inst Detroit MI USA Hackley Hosp Inpatient Med Specialists Inc Muskegon MI USA Univ Alabama Birmingham Birmingham AL USA Univ Calif San Francisco San Francisco CA 94143 USA Genentech Inc San Francisco CA 94080 USA Hlth Serv Res Consultants Seattle WA USA Univ Washington Vet Adm Puget Sound Healthcare Syst Seattle WA 98195 USA Univ Mississippi Jackson MS 39216 USA Initiat Cardiovasc Hlth Dev Countries New Delhi India

Background Immediate reperfusion therapy to restore coronary blood flow is recommended for all eligible patients with acute myocardial infarction. However, reperfusion therapy is reportedly underutilized among African Americans, even when they are eligible. Reasons for the lack of use have not been fully explored. Methods We examined the demographic, clinical, and treatment data of 10,469 African Americans with acute myocardial infarction who were eligible for reperfusion therapy, enrolled in the National Registry of Myocardial Infarction-2 from June 1994 through March 1998. Results The mean age was 62.58 (+/- 14.4) years, and 44.7% were female. Although eligible, 47% of the African Americans in this study did not receive reperfusion therapy. In a multivariate analysis, the absence of chest pain at presentation (odds ratio [OR] 0.31, 95% CI 0.26-0.37) and initial admission diagnoses other than definite myocardial infarction (OR for receipt of reperfusion <0.12) were the strongest predictors of lack of early reperfusion therapy. Progressive delays in hospital arrival and hospital evaluation predicted a lower likelihood of early reperfusion. Prior stroke (OR 0.63, 95% CI 0.50-0.78), myocardial infarction (OR 0.75, 95% CI 0.65-0.86), and congestive heart failure (OR 0.49, 95% CI 0.40-0.60) were all associated with lack of reperfusion therapy. Conclusion Almost half of eligible African American patients with myocardial infarction did not receive reperfusion therapy. Potential reasons may include atypical presentation, patient and institutional delay, and underappreciation of myocardial infarction by care providers. Strategies to address these factors may improve the rate of use of reperfusion therapy.

关键词：急性病非洲裔美国人/统计学和数值数据血管成形术/利用共病现象冠状动脉分流术/利用住院多元分析心肌梗死/诊断心肌梗死/流行病学心肌梗死/外科学心肌再灌注/发展趋势心肌再灌注/利用病人遴选前瞻性研究登记/统计学和数值数据血栓溶解疗法/利用时间因素治疗结果女(雌)性人类男(雄)性中年人

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RECENT LIFE CHANGES AND CORONARY HEART-DISEASE IN EAST VERSUS WEST FINLAND

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JOURNAL OF PSYCHOSOMATIC RESEARCH 1976年第5期20卷 431-437页

作者： RAHE, RH ARAJARVI, H ARAJARVI, S PUNSAR, S KARVONEN, MJ USN CTR HLTH RES SAN DIEGO CA 92152 USA FINNISH HEART ASSOC HELSINKI FINLAND UNIV HELSINKI DEPT PUBL HLTH SF-00290 HELSINKI FINLAND

Coronary heart disease (CHD) is not equally prevalent in East vs. West Finland. Substantially higher CHD rates are found in East Finland, and these higher rates are only partially explained by differences in physiological risk factors such as body mass, blood pressure, cigarette smoking and serum cholesterol levels between persons in these 2 regions. Recent life changes magnitudes were assessed for representative groups of men living in these 2 areas of Finland. East Finns reported approximately 84% higher life change magnitude than West Finns. Subjects'' life changes magnitudes were essentially unrelated to their physiological risk factors. The relatively increased life change levels seen for East Finns may constitute an environmental risk factor for CHD.

关键词：心绞痛/流行病学血压身高体重胆固醇/血液冠心病/流行病学家庭特征芬兰生活变动事件死亡率心肌梗死/流行病学危险吸烟/流行病学人类男(雄)性中年人

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Characterization and clinical course of patients not receiving aspirin for acute myocardial infarction:: Results from the MITRA and MIR studies

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AMERICAN HEART JOURNAL 2001年第2期141卷 200-205页

作者： Frilling, B Schiele, R Gitt, AK Zahn, R Schneider, S Glunz, HG Gieseler, U Baumgärtel, B Asbeck, F Senges, J Herzzentrum Ludwigshafen Dept Cardiol D-67063 Ludwigshafen Germany Westpfalzklinikum Kaiserslautern Germany Kreiskrankenhaus Freital Freital Germany Stadt Krankenhaus Kiel Kiel Germany

Background Clinical trials have shown the efficacy of aspirin for acute myocardial infarction (AMI). However, not all patients receive aspirin for AMI. The aim of this study was to provide information on characteristics and clinical course of patients not treated with aspirin for AMI. Methods We analyzed the data of the Myocardial Infarction Registry (MIR) and the Maximal individual Therapy of Acute Myocardial Infarction (MITRA) registry. MITRA and MIR were prospective multicenter registries of patients with ST segment elevation myocardial infarction in Germany. Results of 22,572 patients registered from 1994 to 1998, 1767 (7.8%) did not receive aspirin within the First 48 hours after admission. Multivariate analysis revealed two main factors associated with withholding aspirin for AMI: relative contraindications to aspirin (gastric ulcer [odds ratio (OR) 4.9, 95% confidence interval (CI) 3.7-5.7], renal insufficiency [OR 1.4, 95% CI 1.1-1.8]), and critical clinical state at admission (cardiogenic shock EOR 1.5, 95% CI 1.2-2.1] and prehospital resuscitation [OR 1.8, 95% CI 1.4-2.2]). In addition, these patients were significantly less likely to receive reperfusion therapy and adjunctive medical therapy such as beta -blockers and angiotensin-converting enzyme inhibitors. In-hospital mortality after adjustment for baseline characteristics was 27.2% in patients without aspirin compared with 11.1% in patients treated with aspirin. Conclusions only a minority of AMI patients (7.8%) did not receive aspirin. Relative contraindications to aspirin and a critical clinical state at admission were the main factors associated with withholding aspirin for AMI. Even after adjustment for patient characteristics, the mortality of patients without aspirin was almost three times higher.

关键词：阿司匹林/治疗应用德国/流行病学住院/统计学和数值数据医院社区/统计学和数值数据心肌梗死/药物疗法心肌梗死/流行病学血小板聚集抑制剂/治疗应用前瞻性研究登记/统计学和数值数据存活率老年人女(雌)性人类男(雄)性

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Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: The Atherosclerosis Risk in Communities study

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AMERICAN HEART JOURNAL 2003年第3期146卷 459-464页

作者： Ding, JZ Roux, AVD Nieto, FJ McNamara, RL Hetmanski, JB Taylor, HA Tyroler, HA Johns Hopkins Univ Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD 21205 USA Columbia Univ Coll Phys & Surg Div Gen Med New York NY USA Columbia Univ Dept Epidemiol Mailman Sch Publ Hlth New York NY USA Univ Wisconsin Sch Med Dept Populat Hlth Sci Madison WI USA Chinle Comprehens Healthcare Facil Dept Internal Med Chinle AZ USA Univ Mississippi Med Ctr Dept Med Jackson MS 39216 USA Univ N Carolina Sch Publ Hlth Dept Epidemiol Chapel Hill NC USA

Background The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors. Methods A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up. Results Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% Cl, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29;95% Cl, 0.83-2.00), socioeconomic position (1.31;95% CI, 0.83-2.09), severity of MI (1.60;95% Cl, 1.05-2.45), and treatment (1.36;95% Cl, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% Cl, 0.56-1.77). Conclusions Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.

关键词：非洲裔美国人/统计学和数值数据年龄因素欧洲大陆世系人群/统计学和数值数据住院发病率心肌梗死/流行病学心肌梗死/人种学心肌梗死/死亡率比例危险度模型前瞻性研究危险因素性别因素社会经济因素美国/流行病学女(雌)性人类男(雄)性中年人

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SURGICAL VERSUS MEDICAL-TREATMENT OF OCCLUSIVE DISEASE CONFINED TO LEFT ANTERIOR DESCENDING CORONARY-ARTERY

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AMERICAN JOURNAL OF CARDIOLOGY 1975年第6期35卷 836-842页

作者： KOUCHOUKOS, NT OBERMAN, A RUSSELL, RO JONES, WB UNIV ALABAMA MED CTRDEPT SURGUNIV STNBIRMINGHAMAL 35294 UNIV ALABAMA SCH MEDDEPT SURGBIRMINGHAMAL UNIV ALABAMA SCH MEDDEPT MEDBIRMINGHAMAL UNIV ALABAMA SCH MEDDEPT PUBL HLTH & EPIDEMIOLBIRMINGHAMAL

The results of saphenous vein bypass grafting and medical treatment were compared in 53 patients with stable angina pectoris, high grade occlusive disease confined to the left anterior descending coronary artery and normal or minimally impaired left ventricular function. Survival, incidence of myocardial infarction, relief of angina and response to exercise testing were evaluated. In the 29 surgically treated patients, followed up a mean of 24 months, there were two late deaths (7 percent) and five myocardial infarctions (17 percent). Twelve patients (41 percent) were free of angina and the majority had increased exercise performance when tested up to 18 months postoperatively. In the 24 medically treated patients, there were no deaths and one myocardial infarction (4 percent) in a mean follow-up period of 37 months. Six patients (25 percent) were free of angina. Less improvement in exercise performance was observed than in the surgically treated group. This subset of patients with isolated left anterior descending coronary artery disease has a favorable prognosis that is not enhanced by bypass grafting. Surgical treatment is more effective than medical treatment in relieving angina and improving exercise performance in the early years after coronary arteriography.

关键词：心绞痛/治疗侧支循环冠状动脉分流术冠状动脉循环冠心病/病理生理学冠心病/外科学冠心病/治疗心电描记术运动试验随访研究心脏/病理生理学心肌梗死/流行病学预后隐静脉女(雌)性人类男(雄)性中年人

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Two-decade-long trends (1975-1997) in the incidence, hospitalization, and long-term death rates associated with complete heart block complicating acute myocardial infarction: A community-wide perspective

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AMERICAN HEART JOURNAL 2003年第3期145卷 500-507页

作者： Spencer, FA Jabbour, S Lessard, D Yarzebski, J Ravid, S Zaleskas, V Hyder, M Gore, JM Goldberg, RJ Univ Massachusetts Sch Med Dept Med Div Cardiovasc Med Worcester MA 01655 USA Lown Cardiovasc Res Fdn Brookline MA USA

Background The purpose of this community-wide study was to describe a >2-decade-long experience (1975-97) in the incidence and death rates associated with complete heart block (CHB) in patients with acute myocardial infarction (AMI). Limited population-based: data exist describing recent, and changes with time therein, incidence and case-fatality rates associated with CHB complicating AMI. Methods We conducted an observational study of 9082 metropolitan Worcester, Mass, residents (1990 census 437,000) hospitalized with validated AMI in all greater Worcester hospitals during 11 1-year periods between 1975 and 1997. Results Overall, CHB developed in 5.0 % of patients with AMI. The incidence rates of CHB declined in the periods studied (6.0% in 1975/78 vs 3.1 % in 1997). Declines in the occurrence of CHB were noted in patients with anterior or inferior/posterior MI. These trends remained after adjustment for other factors that might affect the risk of CHB. Patients in whom CHB developed experienced significantly higher hospital death rates than patients in whom CHB did not develop (46.8% vs.14.6%). However, improving trends in the hospital survival rate of patients with CHB were observed between 1975/78 (47.4% surviving) and 1997 (61.3% surviving). Patients in whom CHB developed during hospitalization were not at increased risk for dying after hospital discharge. Conclusions our findings indicate that the incidence of CHB complicating AMI has declined with time. The hospital prognosis of patients in whom CHB developed has improved, but these patients remain at an increased risk of hospital mortality. The long-term prognosis of patients with inferior MI and CHB is similar to that of patients in whom CHB did not develop. Patients with anterior MI and CHB may beat an increased risk of long-term mortality.

关键词：急性病共病现象心脏传导阻滞/诊断心脏传导阻滞/流行病学心脏传导阻滞/死亡率医院死亡率/发展趋势住院/统计学和数值数据住院/发展趋势发病率纵向研究马萨诸塞/流行病学死亡率/发展趋势心肌梗死/诊断心肌梗死/流行病学存活率分析老年人女(雌)性人类男(雄)性

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