再灌注时代前后复发性急性心肌梗死患者的预后——一项全国性研究。

Prognosis of patients with a recurrent acute myocardial infarction before and in the reperfusion era--a national study.

作者信息

Shotan A, Gottlieb S, Goldbourt U, Boyko V, Reicher-Reiss H, Arad M, Mandelzweig L, Hod H, Kaplinsky E, Behar S

机构信息

Henry N. Neufeld Cardiac Research Institute and Heart Institute, Sheba Medical Center, Tel Hashomer, Israel 52621.

出版信息

Am Heart J. 2001 Mar;141(3):478-84. doi: 10.1067/mhj.2001.112998.

DOI:10.1067/mhj.2001.112998

PMID:11263449

Abstract

BACKGROUND

Patients with recurrent acute myocardial infarction (AMI) are at increased risk for morbidity and mortality. We compared the outcome of patients with recurrent AMI hospitalized in coronary care units in the prereperfusion and reperfusion eras.

METHODS

The study population comprised 2 large-scale cohorts with recurrent AMI: (1) 1415 (24%) of 5839 consecutive patients with AMI hospitalized in 1981 to 1983 (Secondary Prevention Reinfarction Israeli Nifedipine Trial [SPRINT] Registry) and (2) 1093 (25%) of 4317 patients with AMI from three national surveys performed in 1992 to 1996.

RESULTS

Patients in the 1990s had significantly lower rates of heart failure and cardiogenic shock. The 7-day mortality declined from 18% in 1981-1983 to 10% in 1992-1996 (adjusted odds ratio [OR] 0.57 [0.44-0.75]), the 30-day mortality rate from 26% to 16% (OR 0.56 [0.44-0.71]), and the 1-year mortality rate from 39% to 26% (adjusted hazard ratio [HR] 0.64 [0.54-0.75]), respectively. In the 1992-1996 cohort, the adjusted risk of 7-day, 30-day, and 1-year mortality for patients with recurrent AMI treated with thrombolysis in comparison to patients without thrombolysis was OR 1.69 (1.07-2.65), 1.52 (1.03-2.23), and HR 1.18 (0.90-1.55), respectively. The mortality rate among patients treated with early percutaneous transluminal coronary angioplasty/coronary artery bypass grafting was 3% versus 12% at 7 days (OR 0.36 [0.16-0.73]), 7% versus 18% at 30 days (OR 0.45 [0.25-0.77]), and 16% versus 29% at 1 year (HR 0.64 [0.46-0.96]), in comparison to patients without revascularization.

CONCLUSION

The prognosis of patients with recurrent AMI improved significantly during the reperfusion era. Although thrombolysis may have a limited therapeutic effect among patients with recurrent AMI, an interventional approach seems more appropriate when indicated. A randomized trial of thrombolysis versus early revascularization is needed in patients with recurrent AMI.

摘要

背景

复发性急性心肌梗死（AMI）患者的发病和死亡风险增加。我们比较了在再灌注时代和非再灌注时代入住冠心病监护病房的复发性AMI患者的结局。

方法

研究人群包括两个复发性AMI的大规模队列：（1）1981年至1983年住院的5839例连续AMI患者中的1415例（24%）（以色列硝苯地平二级预防再梗死试验[SPRINT]登记处），以及（2）1992年至1996年进行的三项全国性调查中的4317例AMI患者中的1093例（25%）。

结果

20世纪90年代的患者心力衰竭和心源性休克发生率显著降低。7天死亡率从1981 - 1983年的18%降至1992 - 1996年的10%（调整后的优势比[OR]0.57[0.44 - 0.75]），30天死亡率从26%降至16%（OR 0.56[0.44 - 0.71]），1年死亡率从39%降至26%（调整后的风险比[HR]0.64[0.54 - 0.75]）。在1992 - 1996年队列中，与未接受溶栓治疗的复发性AMI患者相比，接受溶栓治疗的患者7天、30天和1年死亡的调整后风险分别为OR 1.69（1.07 - 2.65）、1.52（1.03 - 2.23）和HR 1.18（0.90 - 1.55）。与未进行血运重建的患者相比，早期经皮冠状动脉腔内血管成形术/冠状动脉旁路移植术治疗的患者7天死亡率为3%，而未治疗的为12%（OR 0.36[0.16 - 0.73]），30天死亡率为7%，而未治疗的为18%（OR 0.45[0.25 - 0.77]），1年死亡率为16%，而未治疗的为29%（HR 0.64[0.46 - 0.96]）。