首次急性心肌梗死后住院期间再梗死的发生率、决定因素及临床病程（来自急性心肌梗死最大个体化治疗[MITRA]和心肌梗死登记[MIR]的汇总数据结果）

Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the maximal individual therapy in acute myocardial infarction [MITRA], and the myocardial infarction registry [MIR]).

作者信息

Dönges K, Schiele R, Gitt A, Wienbergen H, Schneider S, Zahn R, Grube R, Baumgärtel B, Glunz H G, Senges J

机构信息

Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany.

出版信息

Am J Cardiol. 2001 May 1;87(9):1039-44. doi: 10.1016/s0002-9149(01)01458-8.

DOI:10.1016/s0002-9149(01)01458-8

PMID:11348599

Abstract

There are few data about the incidence, determinants, and clinical course of in-hospital repeat acute myocardial infarction (RE-AMI) after an index AMI. From June 1994 to June 1998, 22,613 patients with AMI as an index event were registered by the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registries (MIR). Of these, 1,071 (4.7%) had a RE-AMI. For the index event, 9,143 patients (40.5%) were treated with thrombolysis, 1,707 (7.5%) with primary angioplasty, and 443 (2.0%) with a combination of both. Multivariate analysis showed that previous AMI (odds ratio [OR] 1.59; 95% confidence intervals [CI] 1.35 to 1.86), age >70 years (OR 1.57; 95% CI 1.36 to 1.81), diagnostic first electrocardiogram (OR 1.37; 95% CI 1.19 to 1.59), and female gender (OR 1.14; 95% CI 1.05 to 1.32) were independently associated with a higher incidence of RE-AMI. The incidence of RE-AMI was higher when patients received thrombolysis (OR 1.36; 95% CI 1.15 to 1.61), and it was lower when they underwent primary angioplasty (OR 0.74; 95% CI 0.53 to 1.03) or received beta blockers (OR 0.84; 95% CI 0.72 to 0.97). Patients with RE-AMI had higher hospital mortality compared with those without RE-AMI (OR 4.35; 95% CI 3.83 to 4.95). Multivariate logistic regression analysis showed an independent association of RE-AMI with in-hospital death (OR 6.60; 95% CI 5.61 to 7.70), repeat revascularization (OR 2.91; 95% CI 2.42 to 3.50), low workload capacity on the bicycle ergometry test (OR 2.17; 95% CI 1.71 to 2.76), and ejection fraction <40% (OR 1.72; 95% CI 1.38 to 2.14) at discharge. Thus, RE-AMI occurs in 4.7% of patients after an AMI. Previous AMI, age >70 years, diagnostic first electrocardiogram, and female gender are independent determinants for RE-AMI. Thrombolysis is associated with a higher and beta blockers with a lower incidence of RE-AMI. Once a RE-AMI occurs, it is a strong predictor of in-hospital mortality and morbidity.

摘要

关于首次急性心肌梗死（AMI）后院内再发急性心肌梗死（RE-AMI）的发病率、决定因素及临床病程的数据较少。1994年6月至1998年6月，急性心肌梗死最大个体化治疗（MITRA）和心肌梗死登记处（MIR）登记了22,613例以AMI为首发事件的患者。其中，1071例（4.7%）发生了RE-AMI。对于首发事件，9143例患者（40.5%）接受了溶栓治疗，1707例（7.5%）接受了直接血管成形术，443例（2.0%）接受了两者联合治疗。多变量分析显示，既往AMI（比值比[OR]1.59；95%置信区间[CI]1.35至1.86）、年龄>70岁（OR 1.57；95%CI 1.36至1.81）、诊断性首次心电图（OR 1.37；95%CI 1.19至1.59）及女性性别（OR 1.14；95%CI 1.05至1.32）与RE-AMI的较高发病率独立相关。患者接受溶栓治疗时RE-AMI的发病率较高（OR 1.36；95%CI 1.15至1.61），而接受直接血管成形术时发病率较低（OR 0.74；95%CI 0.53至1.03），接受β受体阻滞剂治疗时发病率也较低（OR 0.84；95%CI 0.72至0.97）。与未发生RE-AMI的患者相比，发生RE-AMI的患者院内死亡率更高（OR 4.35；95%CI 3.83至4.95）。多变量逻辑回归分析显示，RE-AMI与院内死亡（OR 6.60；95%CI 5.61至7.70）、再次血管重建（OR 2.91；95%CI 2.42至3.50）、自行车测力计试验时低工作负荷能力（OR 2.17；95%CI 1.71至2.76）及出院时射血分数<40%（OR 1.72；95%CI 1.38至2.14）独立相关。因此，AMI后4.7%的患者会发生RE-AMI。既往AMI、年龄>70岁、诊断性首次心电图及女性性别是RE-AMI的独立决定因素。溶栓治疗与RE-AMI的较高发病率相关，而β受体阻滞剂与之相关的发病率较低。一旦发生RE-AMI，它是院内死亡率和发病率的有力预测指标。