Duke Clinical Research Institute, Durham, NC; Shanghai Renji Hospital, Department of Cardiology, Shanghai, China.
Duke Clinical Research Institute, Durham, NC.
Am Heart J. 2014 Jun;167(6):840-5. doi: 10.1016/j.ahj.2014.03.009. Epub 2014 Apr 3.
Prior myocardial infarction (MI) is a known risk factor for long-term mortality among acute MI patients; but its prevalence and implications for the short-term outcomes of patients with a new, acute MI remain uncertain.
We studied a total of 319,152 consecutively enrolled ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) patients in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (01/2007-03/2012). Baseline characteristics, home and in-hospital treatments, mortality rates, and major bleeding were compared separately for STEMI and NSTEMI by prior MI status, with adjustment for mortality and major bleeding.
Prior MI was documented in 19% of STEMI (n = 124,535) and 29% of NSTEMI (n = 194,617) patients, who were older, were more likely to have comorbidities or prior revascularization, and were more commonly taking secondary prevention medications at home. Guideline-recommended treatments in-hospital and at discharge did not differ in prior-MI STEMI patients, but invasive management was lower for prior-MI NSTEMI patients. The frequency of in-hospital mortality was higher for prior-MI STEMI (5.9% vs. 5.2%) and NSTEMI patients (4.3% vs. 3.4%). After adjustment, the excess mortality risk associated with prior MI was no longer present for STEMI (odds ratio = 1.06, 95% CI 0.97-1.15), with only modest excess risk for NSTEMI (odds ratio = 1.10, 95% CI 1.04-1.15). The risk of in-hospital major bleeding was marginally lower for prior-MI NSTEMI.
More than 20% of patients with acute MI treated in contemporary practice have a history of a prior MI; despite differences in the baseline risk profile, there was little difference in the adjusted risk of in-hospital mortality by prior-MI status.
先前的心肌梗死（MI）是急性 MI 患者长期死亡的已知危险因素；但其在新发急性 MI 患者短期预后中的发生率及其意义仍不确定。
我们研究了国家心血管数据注册中心急性冠状动脉治疗和干预结局网络注册-遵循指南（2007 年 1 月至 2012 年 3 月）中连续纳入的 319152 例 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）患者。分别比较 STEMI 和 NSTEMI 患者的既往 MI 状态，比较基线特征、家庭和院内治疗、死亡率和大出血，死亡率和大出血进行了调整。
STEMI（n=124535）和 NSTEMI（n=194617）患者中有 19%和 29%记录了既往 MI，既往 MI STEMI 和 NSTEMI 患者年龄较大，更有可能合并症或既往血运重建，更常在家中服用二级预防药物。既往 MI STEMI 患者的院内和出院时推荐的治疗方法没有差异，但既往 MI NSTEMI 患者的介入治疗较低。既往 MI STEMI（5.9%比 5.2%）和 NSTEMI（4.3%比 3.4%）患者的院内死亡率较高。调整后，STEMI 患者与既往 MI 相关的超额死亡风险不再存在（比值比=1.06，95%CI 0.97-1.15），而 NSTEMI 患者的超额死亡风险仅略有增加（比值比=1.10，95%CI 1.04-1.15）。既往 MI NSTEMI 患者院内大出血的风险略低。
在当代实践中接受治疗的急性 MI 患者中，超过 20%的患者有先前 MI 的病史；尽管基线风险特征存在差异，但既往 MI 状态对院内死亡率的调整风险差异不大。
