冠心病(CHD)在世界范围内都是最重要的死因。[4]World Health Organization. Deaths from coronary heart disease [internet publication].http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_14_deathHD.pdf 在英国,每 6 名男性和每 10 名女性中就有 1 人死于冠心病。[5]British Heart Foundation. Cardiovascular disease statistics. 2014 [internet publication].https://www.bhf.org.uk/publications/statistics/cardiovascular-disease-statistics-2014 在英国,大约 640 000 名男性和 275 000 名女性在他们一生中的某个时间可能发生心肌梗死,每年发生总数为 175 000 例。[5]British Heart Foundation. Cardiovascular disease statistics. 2014 [internet publication].https://www.bhf.org.uk/publications/statistics/cardiovascular-disease-statistics-2014
在美国≥20 岁的成年人中,心肌梗死的总患病率在 2.8% 左右。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 估测每年新发心肌梗死 550,000 例,复发心肌梗死 200,000 例。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 根据美国心脏协会估计,每 42 秒就会有一个美国人患心肌梗死。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 2013 年,美国有 116,793 人死于 MI,其中约 57% 为男性,43% 为女性。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 冠心病的患病风险从整体来看在发达国家已经呈下降趋势,而在发展中国家呈上升趋势。很可能与生活方式的改变、城镇化和预期寿命延长有关。患病风险还随移民而改变(例如在日本居住的人风险低,但是移民到美国后,其风险最终增加至与在美国出生的人的风险相当)。
心肌梗死对男性和女性都有影响,在男性发病的年龄更年轻一些。女性的发病率在绝经期后有所增加。第一次发生心肌梗死的平均年龄在男性为 65.1 岁,女性为 72 岁。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 在患有 STEMI 的女性中,即使在校正药物治疗、初始经皮冠状动脉介入治疗和其他共存疾病后,更轻的年龄也与更高的30 天死亡率相关。[6]Cenko E, Yoon J, Kedev S, et al. Sex differences in outcomes after STEMI: effect modification by treatment strategy and age. JAMA Intern Med. 2018 May 1;178(5):632-9.http://www.ncbi.nlm.nih.gov/pubmed/29630703?tool=bestpractice.com
约有 90% 的冠心病患者至少有一个主要危险因素,包括吸烟、血脂异常、高血压、糖尿病和腹型肥胖。[7]Yusuf S, Hawken S, Ounpuu S, et al; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):937-52.http://www.ncbi.nlm.nih.gov/pubmed/15364185?tool=bestpractice.com
存在 STEMI 的急性冠状动脉综合征患者比例在美国大约为 38%,在欧洲大约为 47%。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com 在美国,急性心肌梗死患者约 15% 会死于该疾病,其中半数死亡发生在症状发作 1 小时内。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com