Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230,Rotterdam, The Netherlands.
Eur J Prev Cardiol. 2012 Dec;19(6):1316-23. doi: 10.1177/1741826711428064. Epub 2011 Oct 19.
Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. We investigated whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and assessed the gain in life expectancy by reperfusion therapy.
We analysed the outcome of 533 patients (mean age 56 years, 82% men), who were randomized to either reperfusion therapy or conventional therapy during 1980-1985. Median follow up was 27 years (25-30 years). At follow up, 59 patients (22%) of the 269 patients allocated to reperfusion treatment and only 39 patients (15%) of the 264 conventionally treated patients were still alive (p = 0.02). The cumulative 10-, 15-, 20-, and 25-year survival rates were 69, 48, 37, and 24% after reperfusion therapy and 59, 38, 27, and 18% in the control group, respectively (p < 0.001). Life expectancy of the reperfusion group was 15.6 years vs. 12.5 years in the conventionally treated group (p < 0.02). Myocardial reinfarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow up. Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge.
These data confirm that the benefits of early reperfusion therapy for acute myocardial infarction are sustained throughout the lifetime of the patients. More than 3 life years were gained by reperfusion therapy.
急性心肌梗死的再灌注治疗可缩小梗死面积并提高住院生存率。我们研究了心肌梗死再灌注治疗的益处是否能长期持续，并评估了再灌注治疗对预期寿命的获益。
我们分析了 533 例患者（平均年龄 56 岁，82%为男性）的结局，这些患者于 1980-1985 年期间被随机分配至再灌注治疗组或常规治疗组。中位随访时间为 27 年（25-30 年）。随访时，269 例接受再灌注治疗的患者中有 59 例（22%），264 例接受常规治疗的患者中仅有 39 例（15%）存活（p=0.02）。再灌注治疗组的 10、15、20 和 25 年累积生存率分别为 69%、48%、37%和 24%，而对照组分别为 59%、38%、27%和 18%（p<0.001）。再灌注治疗组的预期寿命为 15.6 年，而常规治疗组为 12.5 年（p<0.02）。再灌注治疗后心肌再梗死和随后的冠状动脉介入治疗更为频繁，尤其是在治疗后的第一年。多变量分析显示，再灌注治疗是长期随访时死亡率降低的重要独立预测因素。死亡率的其他独立预测因素包括年龄、左心室功能受损、多支血管疾病、梗死面积以及出院时无法进行运动试验。
这些数据证实，急性心肌梗死早期再灌注治疗的益处可贯穿患者的整个生命周期。再灌注治疗可使患者多获得 3 年以上的寿命。
