心血管疾病 (CVD) 是全球第一大死亡原因,每年引起 1750 万例死亡。2012 年,据世界卫生组织估算,全球死亡中三分之一由心血管疾病造成,其中 740 万人死于缺血性心脏病。[7]World Health Organization. Global status report on noncommunicable diseases, 2014. 2014. http://www.who.int/en/ (last accessed 28 July 2017).http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1在很多发达国家,冠心病死亡率在下降。但在许多发展中及转型中的国家,冠心病死亡率在上升,部分原因是寿命延长、城市化和生活方式转变。流行病学数据显示,存在 STEMI 的急性冠状动脉综合征 (ACS) 病例在逐渐减少,而 NSTEMI 较 STEMI 更多见。[4]Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.http://eurheartj.oxfordjournals.org/content/37/3/267.longhttp://www.ncbi.nlm.nih.gov/pubmed/26320110?tool=bestpractice.com[5]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-e322.https://circ.ahajournals.org/content/131/4/e29.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/25520374?tool=bestpractice.com在美国,估计每年有超过 780,000 的人出现急性冠状动脉综合征,其中大约 70% 为 NSTEMI。[1]Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139-e228.http://circ.ahajournals.org/content/130/25/e344.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/25260718?tool=bestpractice.com世界最大的急性冠状动脉综合征患者数据库显示,诊断为非 ST 段抬高型心肌梗死的患者比例正在大幅上升。[8]Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the U.S. from 1990 through 1999. J Am Coll Cardiol. 2000;36:2056-2063.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-41S4TK2-7&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=763c5104f9e80167425c5cec5fc4c471http://www.ncbi.nlm.nih.gov/pubmed/11127441?tool=bestpractice.com这也许是由更加灵敏的心肌损伤检测、更早期的药物治疗以及ST段抬高型心肌梗死的再灌注(和预防)治疗造成的。[8]Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the U.S. from 1990 through 1999. J Am Coll Cardiol. 2000;36:2056-2063.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-41S4TK2-7&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=763c5104f9e80167425c5cec5fc4c471http://www.ncbi.nlm.nih.gov/pubmed/11127441?tool=bestpractice.com[2]Alpert JS, Thygesen K, Antman E, et al. Myocardial infarction redefined - a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36:959-969.http://content.onlinejacc.org/cgi/content/short/36/3/959http://www.ncbi.nlm.nih.gov/pubmed/10987628?tool=bestpractice.com