Trends in Incidence, Severity, and Outcome of Hospitalized Myocardial Infarction

被引:260
作者
Roger, Veronique L. [1 ,2 ]
Weston, Susan A. [1 ]
Gerber, Yariv [1 ,6 ]
Killian, Jill M. [1 ]
Dunlay, Shannon M. [2 ]
Jaffe, Allan S. [2 ]
Bell, Malcolm R. [2 ]
Kors, Jan [3 ]
Yawn, Barbara P. [4 ]
Jacobsen, Steven J. [5 ]
机构
[1] Mayo Clin, Dept Hlth Sci Res, Rochester, MN 55905 USA
[2] Mayo Clin, Div Cardiovasc Dis & Internal Med, Rochester, MN 55905 USA
[3] Erasmus Univ, Dept Med Informat, Med Ctr, NL-3000 DR Rotterdam, Netherlands
[4] Olmsted Med Ctr, Rochester, MN USA
[5] So Calif Permanente Med Grp, Pasadena, CA USA
[6] Tel Aviv Univ, Sackler Sch Med, Sch Publ Hlth, Dept Epidemiol & Prevent Med, IL-69978 Tel Aviv, Israel
基金
美国国家卫生研究院;
关键词
biomarkers; incidence; mortality; myocardial infarction; CORONARY-HEART-DISEASE; ATHEROSCLEROSIS RISK; TEMPORAL TRENDS; OLMSTED COUNTY; CASE-FATALITY; REDEFINITION; MINNESOTA; COMMUNITY; MORTALITY; ASSOCIATION;
D O I
10.1161/CIRCULATIONAHA.109.897249
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-In 2000, the definition of myocardial infarction (MI) changed to rely on troponin rather than creatine kinase (CK) and its MB fraction (CK-MB). The implications of this change on trends in MI incidence and outcome are not defined. Methods and Results-This was a community study of 2816 patients hospitalized with incident MI from 1987 to 2006 in Olmsted County, Minnesota, with prospective measurements of troponin and CK-MB from August 2000 forward. Outcomes were MI incidence, severity, and survival. After troponin was introduced, 278 (25%) of 1127 incident MIs met only troponin-based criteria. When cases meeting only troponin criteria were included, incidence did not change between 1987 and 2006. When restricted to cases defined by CK/CK-MB, the incidence of MI declined by 20%. The incidence of non-ST-segment elevation MI increased markedly by relying on troponin, whereas that of ST-segment elevation MI declined regardless of troponin. The age-and sex-adjusted hazard ratio of death within 30 days for an infarction occurring in 2006 (compared with 1987) was 0.44 (95% confidence interval, 0.30 to 0.64). Among 30-day survivors, survival did not improve, but causes of death shifted from cardiovascular to noncardiovascular (P=0.001). Trends in long-term survival among 30-day survivors were similar regardless of troponin. Conclusions-Over the last 2 decades, a substantial change in the epidemiology of MI occurred that was only partially mediated by the introduction of troponin. Non-ST-segment elevation MIs now constitute the majority of MIs. Although the 30-day case fatality improved markedly, long-term survival did not change, and the cause of death shifted from cardiovascular to noncardiovascular. (Circulation. 2010; 121:863-869.)
引用
收藏
页码:863 / 869
页数:7
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