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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。
OBJECTIVE: To analyze the in-hospital mortality and its distribution of acute myocardial infarction (AMI) in Beijing residents aged 25 years and older from 2007 to 2009. Methods: The research information was collected from Beijing Discharge Patient Information System of Beijing Public Health Information Center. AMI In-hospital mortality refers to the proportion of patients hospitalized for AMI who died during AMI among all AMI inpatients. Results: From 2007 to 2009, a total of 35 335 residents aged 25 or above with household registration in Beijing were enrolled, of whom 68.2% were male. The average in-hospital mortality was 10.0% in AMI patients at 3 years and 14.3% in women, up from 7.9% in men (P <0.001). In-hospital mortality rates were higher in AMI patients than those in tertiary hospitals (11.4% vs 9.0%, P <0.001), and those in TCM hospitals were higher than those in Western hospitals (17.5% vs 9.5%, P <0.001). In-hospital mortality was higher in AMI patients with ST-segment elevation than in non-ST-segment elevation patients (9.4% vs 8.4%, P <0.001). In-hospital mortality was significantly higher in those who did not receive percutaneous coronary intervention than in those who received it (14.4% vs 1.9%, p <0.001). In 2007, 2008 and 2009, the annualized AMI inpatient mortality rate in Beijing was 10.7%, 9.8% and 9.4% respectively, with a decrease of 12.1% in three years and 11.1% and 10.7% in males and females respectively. Conclusion: At present, the mortality rate of AMI in Beijing is still high, but it has been declining year by year in the past three years, suggesting that the overall level of rescuing during the AMI stay in Beijing is generally higher. In-hospital mortality of AMI patients with different characteristics is different. The results provide a basis for further improving the inpatient treatment of AMI in Beijing.