Epidemiology Unit, Local Health Unit 10-Firenze, Florence, Italy.
J Cardiovasc Med (Hagerstown). 2012 Dec;13(12):819-27. doi: 10.2459/JCM.0b013e328356a29c.
Long-term prognosis of ST segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (pPCI) remains relatively poorly investigated in unselected patients. This study analyzed 8-year follow-up of STEMI patients enrolled in the Florence Acute Myocardial Infarction Registry, a population-based, observational study performed in Italy in 2000-2001.
The prognostic effect of pPCI adjusted for clinical and demographic characteristics on a composite end-point of new myocardial infraction, urgent revascularization or death, and on all-cause mortality separately, was assessed in multivariable Cox analysis, calculating hazard ratios and 95% confidence intervals. This analysis is concerned with 875 STEMI patients (mean age 70.6 ± 12.9 years), treated with pPCI (459) or conservatively (416).
After 8 years, 59% of patients had experienced the composite end-point and 49% had died. The multivariable analysis showed a significantly better prognosis in patients receiving pPCI (hazard ratio 0.72, P = 0.001), evident also in the 645 patients who were event-free after the first year of follow-up (hazard ratio 0.72, P = 0.010). Other independent prognostic factors were advanced age, Killip class greater than 1, some cardiovascular or noncardiovascular comorbidities, in-hospital cardiogenic shock, ejection fraction less than 30%, and treatment with aspirin and statin during hospitalization. The beneficial effect of pPCI observed both in cases younger (adjusted hazard ratio 0.65, P = 0.013) and older than 75 years (adjusted hazard ratio 0.65, P = 0.001) was also confirmed considering as outcome all-cause mortality only.
In unselected STEMI patients, survival advantage from pPCI extends for a long term (8 years). This survival advantage is maintained at advanced ages, thus enforcing the importance of improving delivery of appropriate care to older STEMI patients.
在经皮冠状动脉介入治疗（pPCI）时代，对未经选择的 ST 段抬高型心肌梗死（STEMI）患者的长期预后研究相对较少。本研究分析了 2000-2001 年在意大利进行的基于人群的佛罗伦萨急性心肌梗死注册研究中入组的 STEMI 患者的 8 年随访结果。
多变量 Cox 分析调整了临床和人口统计学特征后，评估 pPCI 对新发心肌梗死、紧急血运重建或死亡的复合终点以及全因死亡率的预后影响，计算了危险比和 95%置信区间。该分析涉及 875 例 STEMI 患者（平均年龄 70.6±12.9 岁），分别接受 pPCI（459 例）或保守治疗（416 例）。
8 年后，59%的患者发生了复合终点事件，49%的患者死亡。多变量分析显示，接受 pPCI 的患者预后明显更好（危险比 0.72，P=0.001），在首次随访 1 年后无事件的 645 例患者中也存在同样的结果（危险比 0.72，P=0.010）。其他独立的预后因素包括年龄较大、Killip 分级＞1、存在心血管或非心血管合并症、住院期间心源性休克、射血分数＜30%，以及住院期间使用阿司匹林和他汀类药物。在年龄较小（调整后的危险比 0.65，P=0.013）和年龄较大（调整后的危险比 0.65，P=0.001）的患者中观察到的 pPCI 获益也得到了确认，仅将全因死亡率作为结局。
在未经选择的 STEMI 患者中，pPCI 的生存优势可延长至 8 年以上。这种生存优势在高龄患者中仍然存在，因此加强了改善对老年 STEMI 患者提供适当治疗的重要性。
