AMI真的變少了!

Trends in Acute Myocardial Infarction: More Good News

Evidence is mounting that improvements in prevention and treatment are having favorable effects on incidence and outcomes.

Recent studies of trends in acute myocardial infarction (AMI) have not included comprehensive information on MI type, diagnostic criteria, and medications. Now, investigators have examined data on 46,086 hospitalizations for AMI and 18,691,131 person-years of follow-up from the Kaiser Permanente Northern California integrated healthcare system between 1999 and 2008. They assessed changes in patient characteristics, medication use, biomarker levels, and outcomes using administrative codes to distinguish between ST-segment-elevation MI (STEMI) and non–ST-segment-elevation MI (NSTEMI).

During the study period, the hospitalization rate declined by 24%, and the proportion of STEMI events fell markedly. By the end of the study, patients were significantly older and more likely to be female, to have comorbidities, and to have previously undergone coronary revascularization than at the beginning of the study. Rates of prehospitalization use of statins, angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers, and beta-blockers all increased significantly, and median peak levels of creatine kinase-MB decreased. The adjusted odds ratio for 30-day mortality dropped significantly, by 24%. A 6.5% increase in the rate of revascularization within 30 days after MI was driven by a substantial increase in percutaneous coronary intervention (PCI).

Comment: The authors' use of administrative codes (which can be inaccurate) to classify the type of MI limits the strength of their conclusions. Nonetheless, these results are consistent with those of two studies in the Medicare population; one (JW Cardiol Sep 9 2009) showing a marked recent decline in AMI mortality, and the other (JW Gen Med Apr 20 2010) showing a marked reduction in hospitalizations for MI. The findings also reinforce those of recent studies showing increased PCI rates.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology June 9, 2010


https://docs.google.com/fileview?id=0B278nGJMQBk7ZDYyYmRlYTEtOWYxYS00NzgzLTg5NjgtYTE2NWIwOGQwYmIw&hl=en


impact model -> 闡述risk factor reduction + treatment advance對AMI mortality 的影響



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