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入院した心筋梗塞の発生率,重症度,結果の傾向
Véronique L Roger1, Susan A Weston, Yariv Gerber
1MPH, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. roger.veronique@mayo.edu
Circulation
|February 10, 2010
まとめ
トロポニンアッセイの導入は,心筋梗塞 (MI) の診断を大幅に変更し,非STセグメント上昇MI症例を増加させました. 30日間の生存率が改善した一方で,長期的な結果と死因は変化した.
科学分野:
- 心臓病学 心臓病学
- エピデミオロジー エピデミオロジー
- バイオマーカー バイオマーカー
背景:
- 心筋梗塞 (MI) の診断基準は2000年に変化し,クリエチンキナーゼ (CK) やCK-MBよりもトロポニンを優先した.
- この診断上の変化が心筋梗塞の発生率や患者のアウトカムに与える影響は不明のままである.
研究 の 目的:
- トロポニンベースの定義が心筋梗塞の発生率,重症度,生存傾向に及ぼす影響を調査する.
- トロポニンアッセイを採用する前と後のMIの疫学とアウトカムの変化を分析する.
主な方法:
- コミュニティベースの研究では,1987年から2006年の間にインシデントMIで入院した2816人の患者を分析した.
- 将来のトロポニンとCK-MBの測定値は,2000年8月以降に収集されました.
- MIの発生率,重症度,生存率は,異なる診断期間の間で比較されました.
主要な成果:
- トロポニンのみの症例を含めると,全体的なMI発生率 (1987年−2006年) は変化しませんでしたが,それらを除外すると20%の減少を示しました.
- トロポニンの使用により,非STセグメント上昇MI診断は顕著に増加し,STセグメント上昇MI診断は減少しました.
- 心臓発作後の30日間の死亡率は著しく改善した (2006年のHRは0.44対1987年),死因は心血管から非心血管へと変化した.
結論:
- トロポニン診断への移行は,部分的にMIの流行病の進化を説明し,非STセグメントの上昇MIが優勢になっている.
- 短期生存率が改善したにもかかわらず,長期的な生存傾向は変わらなかった.
- 心血管疾患から非心血管疾患への死亡原因の有意なシフトは,MI後の観察された.
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