Björck Lena, Wallentin Lars, Stenestrand Ulf, Lappas George, Rosengren Annika
Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85 Göteborg, Sweden.
Arch Intern Med. 2010 Aug 9;170(15):1375-81. doi: 10.1001/archinternmed.2010.203.
The extent and the severity of acute myocardial infarction (MI) is decreasing. Out-of-hospital medical management before the hospital admission could alter clinical presentation in acute MI. We used a large national patient register to investigate the relation between previous medication use (aspirin, beta-blockers, angiotensin-converting enzyme [ACE] inhibitors, and statins) and the risk of presenting with ST-segment elevation MI (STEMI) or non-STEMI.
We included 103 459 consecutive patients from the Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA) admitted between January 1, 1996, and December 31, 2006, with a first acute MI.
The patients with STEMI (43.5% of the total) were younger, had less prior cardiovascular disease, and used fewer medications before hospitalization. Of the STEMI patients, 61.4% had used no medication vs 45.9% of the patients with non-STEMI. After multiple adjustments, use of aspirin, beta-blockers, ACE inhibitors, and statins before hospitalization were all associated with substantially lower odds of presenting with STEMI. Furthermore, the risk decreased with the number of previous medications, and the use of 3 or more medications was associated with a multiply adjusted odds ratio of presenting with STEMI of 0.48 (99% confidence interval, 0.44-0.52) compared with no medications at admission.
Use of aspirin, beta-blockers, ACE inhibitors, or statins before hospital admission in patients with a first acute MI is associated with substantially less risk of presenting with STEMI. The risk decreases with the increasing number of these medications used before acute MI, underlining the benefit of preventive medication in high-risk patients.
急性心肌梗死（MI）的范围和严重程度正在降低。入院前的院外医疗管理可能会改变急性心肌梗死的临床表现。我们使用了一个大型国家患者登记数据库来研究既往用药情况（阿司匹林、β受体阻滞剂、血管紧张素转换酶[ACE]抑制剂和他汀类药物）与ST段抬高型心肌梗死（STEMI）或非STEMI发病风险之间的关系。
我们纳入了1996年1月1日至2006年12月31日期间瑞典心脏重症监护入院信息与知识登记数据库（RIKS-HIA）中连续收治的103459例首次发生急性心肌梗死的患者。
STEMI患者（占总数的43.5%）更年轻，既往心血管疾病较少，住院前用药较少。在STEMI患者中，61.4%未用药，而非STEMI患者中这一比例为45.9%。经过多次调整后，住院前使用阿司匹林、β受体阻滞剂、ACE抑制剂和他汀类药物均与STEMI发病几率大幅降低相关。此外，风险随着既往用药数量的增加而降低，与入院时未用药相比，使用3种或更多药物与多因素调整后STEMI发病的优势比为0.48（99%置信区间，0.44-0.52）。
首次发生急性心肌梗死的患者在入院前使用阿司匹林、β受体阻滞剂、ACE抑制剂或他汀类药物与STEMI发病风险大幅降低相关。急性心肌梗死前使用这些药物的数量增加，风险降低，这突出了预防性用药对高危患者的益处。
