Arós Fernando, Heras Magda, Vila Joan, Sanz Héctor, Ferreira-González Ignacio, Permanyer-Miralda Gaietà, Cuñat José, López-Bescós Lorenzo, Cabadés Adolfo, Loma-Osorio Angel, Marrugat Jaume
Servicio de Cardiología, Hospital Txagorritxu, José Atxotegi, s/n, 01009 Vitoria-Gasteiz, Álava, España.
Rev Esp Cardiol. 2011 Nov;64(11):972-80. doi: 10.1016/j.recesp.2011.05.011. Epub 2011 Jul 30.
To determine whether mortality from acute myocardial infarction has reduced in Spain and the possibly related therapeutic factors.
Nine thousand, nine hundred and forty-nine patients with ST-segment elevation myocardial infarction admitted to the Coronary Care Unit were identified from PRIAMHO I, II and MASCARA registries performed in 1995, 2000 and 2005, with a 6 month follow-up.
From 1995 to 2005 patients were increasingly more likely to have hypertension, hyperlipidemia and anterior infarction, but age of onset and the proportion of females did not increase. Twenty-eight-day mortality rates were 12.6%, 12.3% and 6% in 1995, 2000 and 2005 respectively, and 15.3%, 14.6% and 9.4% at 6 months (both P-trend <.001). Multivariate analysis was performed and the adjusted odds ratio for 28-day mortality for an infarction occuring in 2005 (compared with 1995) was 0.62 (95% confidence interval: 0.44-0.88) whereas the adjusted hazard ratio for mortality at 6 months was 0.40 (95% confidence interval: 0.24-0.67). Other variables independently associated with lower mortality at 28 days were: reperfusion therapy, and the use of anti-thrombotic treatment, beta-blockers and angiotensin-converting enzyme inhibitors. The 28-day-6-month period had an independent protective effect on the following therapies: coronary reperfusion, and prescription of antiplatelet agents, beta-blockers and lipid lowering drugs upon discharge.
Twenty-eight-day and six-month mortality rates fell among patients with ST-elevation myocardial infarction in Spain from 1995 to 2005. The possibly related therapeutic factors were the following: more frequent reperfusion therapy and increased use of anti-thrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors and lipid lowering drugs.
确定西班牙急性心肌梗死死亡率是否有所降低以及可能与之相关的治疗因素。
从1995年、2000年和2005年进行的PRIAMHO I、II和MASCARA登记中识别出9949例入住冠心病监护病房的ST段抬高型心肌梗死患者，并进行6个月的随访。
从1995年到2005年，患者患高血压、高脂血症和前壁梗死的可能性越来越大，但发病年龄和女性比例并未增加。1995年、2000年和2005年的28天死亡率分别为12.6%、12.3%和6%，6个月时分别为15.3%、14.6%和9.4%（P趋势均<0.001）。进行了多变量分析，2005年发生梗死的患者28天死亡率的调整优势比（与1995年相比）为0.62（95%置信区间：0.44 - 0.88），而6个月时死亡率的调整风险比为0.40（95%置信区间：0.24 - 0.67）。与28天较低死亡率独立相关的其他变量包括：再灌注治疗、抗血栓治疗、β受体阻滞剂和血管紧张素转换酶抑制剂的使用。28天至6个月期间对以下治疗有独立的保护作用：冠状动脉再灌注以及出院时抗血小板药物、β受体阻滞剂和降脂药物的处方。
1995年至2005年，西班牙ST段抬高型心肌梗死患者的28天和6个月死亡率下降。可能与之相关的治疗因素如下：更频繁的再灌注治疗以及抗血栓药物、β受体阻滞剂、血管紧张素转换酶抑制剂和降脂药物使用的增加。
