2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究

摘要

Objective;To assess the recent in-hospital case-fatality rate of acute myocardial infarction (AMI)and its distribution in Beijing. Methods:Data for patients hospitalized for AMI during Jan. 1, 2007 to Dec. 31, 2009, coded as 121 or 122 (ICD-10) in the primary discharge diagnosis field, were extracted from Beijing Hospital Discharge Information System,which is conducted by Beijing Public Health Information Center. The in-hospital case-fatality rate of AMI is defined as the percentage of people diagnosed as having AMI who die during hospitalization. Results;Totally 35 335 patients aged 25 years or more among the permanent residences were identified in Beijing. The age was (65. 5 ± 12.9) years ( mean ± standard deviation) and 68. 2% were men. The average in-hospital case-fatality rate for AMI during 2007 - 2009 was 10. 0% ,and the rate was higher in women than that in men( 14. 3% vs. 7. 9% , P <0.001) , higher in secondary hospitals than that in tertiary hospitals( 11.4% vs. 9. 0% ,P <0. 001), and higher in hospitals of traditional Chinese medicine than that in hospitals of western medicine( 17.5% vs. 9. 5% ,P <0. 001). Patients with ST-elevation myocardial infarction had higher in-hospital case-fatality rate than those with non-ST-elevation myocardial infarction (9. 4% vs.8.4% , P < 0. 001), and patients who did not have percutaneous coronary intervention ( PCI) during hospitali-zation had significantly higher in-hospital case-fatality rate than those had PCI( 14.4% vs. 1. 9% ,P <0. 001). The age-standardized in-hospital case-fatality rate was 10. 7% ,9. 8% and 9. 4% in 2007,2008 and 2009,respectively. Compared with the rate in 2007, the rate declined by 12. 1% in 2009,and the declines were also noticed in both men and women. For men, in-hospital case-fatality rate declined by 11. 1% , from 9.9% in 2007 to 8. 8% in 2009. For women,in-hospital case-fatality rate declined by 10. 7% ,from 12. 2% in 2007 to 10. 9% in 2009. Conclusion;The recent in-hospital case-fatality rate for AMI is still high in Beijing. However, a decline was noticed during 2007 - 2009, indicating the improvement in the in-hospital treatments of AMI in Beijing. Differences in in-hospital case-fatality rates exist among AMI patients with different characteristics. Results from the present study may guide future health care planning and help to determine priorities for clinical treatment.%目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征.方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统.AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例.结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2％.3年中AMI患者平均住院病死率为10.0％,女性为14.3％,高于男性的7.9％ (P ＜0.001).在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4％比9.0％,P＜0.001),中医医院高于西医医院者(17.5％比9.5％,P＜0.001).ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4％比8.4％,P＜0.001).住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4％比1.9％,P＜0.001).2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7％、9.8％和9.4％,3年间下降了12.1％,男女两性分别下降了11.1％和10.7％.结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高.不同特征AMI患者的住院病死率存在差异.研究结果为进一步改善北京市AMI的住院治疗水平提供了依据.