Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
Eur J Prev Cardiol. 2014 May;21(5):576-83. doi: 10.1177/2047487312460514. Epub 2012 Sep 13.
Several risk factors for coronary heart disease (CHD) have been associated with improved in-hospital survival after myocardial infarction (MI). We aimed to confirm this paradox and assess whether it extends to long-term outcome. In addition, we investigated temporal mortality trends.
We examined the relation between the presence of four modifiable risk factors for CHD (hypertension, dyslipidaemia, diabetes mellitus and smoking) and mortality in 14,434 consecutive patients admitted with MI to a coronary care unit from 1985 to 2008.
Two-thirds of MI patients (n = 10,003) had at least one risk factor for CHD on hospital admission. The presence of at least one compared to no CHD risk factors was associated with a favourable 30-day mortality rate (5% vs. 7%, adjusted odds ratio 0.72, 95% confidence interval (CI): 0.62-0.83). There was significant interaction between the presence of CHD risk factors and decade of hospitalization (p = 0.001). The adjusted 10-year mortality hazard ratio (HR) of at least one CHD risk factor compared to none, was 1.2 (95% CI: 1.0--1.4), 0.89 (0.65--1.2) and 0.89 (0.79--0.99) in 1985--1990, 1990--2000 and 2000--2008, respectively. Survival improved over time. Adjusted 10-year mortality fell (adjusted HR [2000--2008 vs. 1985--1990] 0.59 [95% CI: 0.52--0.66] in patients with, and 0.76 [95% CI: 0.65-0.89] in those without CHD risk factors).
The presence of at least one modifiable CHD risk factor was associated with improved outcome after MI. Patients with CHD risk factors benefited from more substantial mortality reductions during the past few decades.
一些冠心病（CHD）的危险因素与心肌梗死（MI）后的住院生存率提高有关。我们旨在证实这一悖论，并评估其是否会扩展到长期预后。此外，我们还研究了时间相关的死亡率趋势。
我们检查了 1985 年至 2008 年期间，在冠状动脉护理病房因 MI 入院的 14434 例连续患者中，四种可改变的 CHD 危险因素（高血压、血脂异常、糖尿病和吸烟）的存在与死亡率之间的关系。
三分之二的 MI 患者（n=10003）在入院时至少有一种 CHD 危险因素。与无 CHD 危险因素相比，至少有一种危险因素与 30 天死亡率降低相关（5%对 7%，调整后比值比 0.72，95%置信区间（CI）：0.62-0.83）。CHD 危险因素的存在与住院时间的十年存在显著交互作用（p=0.001）。与无 CHD 危险因素相比，至少有一种 CHD 危险因素的患者的 10 年死亡风险比为 1.2（95%CI：1.0-1.4）、0.89（95%CI：0.65-1.2）和 0.89（0.79-0.99），分别为 1985-1990 年、1990-2000 年和 2000-2008 年。随着时间的推移，生存率有所提高。10 年死亡率下降（2000-2008 年与 1985-1990 年相比，调整后的 HR [95%CI：0.52-0.66]），在有 CHD 危险因素的患者中，和在无 CHD 危险因素的患者中为 0.76 [95%CI：0.65-0.89]）。
至少有一种可改变的 CHD 危险因素的存在与 MI 后预后改善有关。在过去几十年中，有 CHD 危险因素的患者受益于更大幅度的死亡率降低。
