Alnasser Sami M A, Huang Wei, Gore Joel M, Steg Ph Gabriel, Eagle Kim A, Anderson Frederick A, Fox Keith A A, Gurfinkel Enrique, Brieger David, Klein Werner, van de Werf Frans, Avezum Álvaro, Montalescot Gilles, Gulba Dietrich C, Budaj Andrzej, Lopez-Sendon Jose, Granger Christopher B, Kennelly Brian M, Goldberg Robert J, Fleming Emily, Goodman Shaun G
Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Ont., Canada; King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia.
Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester.
Am J Med. 2015 Jul;128(7):766-75. doi: 10.1016/j.amjmed.2014.12.007. Epub 2014 Dec 29.
Short-term outcomes have been well characterized in acute coronary syndromes; however, longer-term follow-up for the entire spectrum of these patients, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, is more limited. Therefore, we describe the longer-term outcomes, procedures, and medication use in Global Registry of Acute Coronary Events (GRACE) hospital survivors undergoing 6-month and 2-year follow-up, and the performance of the discharge GRACE risk score in predicting 2-year mortality.
Between 1999 and 2007, 70,395 patients with a suspected acute coronary syndrome were enrolled. In 2004, 2-year prospective follow-up was undertaken in those with a discharge acute coronary syndrome diagnosis in 57 sites.
From 2004 to 2007, 19,122 (87.2%) patients underwent follow-up; by 2 years postdischarge, 14.3% underwent angiography, 8.7% percutaneous coronary intervention, 2.0% coronary bypass surgery, and 24.2% were re-hospitalized. In patients with 2-year follow-up, acetylsalicylic acid (88.7%), beta-blocker (80.4%), renin-angiotensin system inhibitor (69.8%), and statin (80.2%) therapy was used. Heart failure occurred in 6.3%, (re)infarction in 4.4%, and death in 7.1%. Discharge-to-6-month GRACE risk score was highly predictive of all-cause mortality at 2 years (c-statistic 0.80).
In this large multinational cohort of acute coronary syndrome patients, there were important later adverse consequences, including frequent morbidity and mortality. These findings were seen in the context of additional coronary procedures and despite continued use of evidence-based therapies in a high proportion of patients. The discriminative accuracy of the GRACE risk score in hospital survivors for predicting longer-term mortality was maintained.
急性冠状动脉综合征的短期预后已得到充分描述；然而，对这些患者的整个谱系，包括ST段抬高型心肌梗死、非ST段抬高型心肌梗死和不稳定型心绞痛进行长期随访的情况则较为有限。因此，我们描述了全球急性冠状动脉事件注册研究（GRACE）中接受6个月和2年随访的医院幸存者的长期预后、手术及药物使用情况，以及出院时GRACE风险评分对预测2年死亡率的表现。
1999年至2007年期间，纳入了70395例疑似急性冠状动脉综合征的患者。2004年，对57个地点出院诊断为急性冠状动脉综合征的患者进行了为期2年的前瞻性随访。
2004年至2007年，19122例（87.2%）患者接受了随访；出院2年后，14.3%的患者接受了血管造影，8.7%接受了经皮冠状动脉介入治疗，2.0%接受了冠状动脉搭桥手术，24.2%再次住院。在接受2年随访的患者中，使用了阿司匹林（88.7%）、β受体阻滞剂（80.4%）、肾素 - 血管紧张素系统抑制剂（69.8%）和他汀类药物（80.2%）治疗。发生心力衰竭的患者占6.3%，（再）梗死的患者占4.4%，死亡的患者占7.1%。出院至6个月的GRACE风险评分对2年全因死亡率具有高度预测性（c统计量为0.80）。
在这个大型跨国急性冠状动脉综合征患者队列中，存在重要的后期不良后果，包括频繁的发病和死亡。尽管在高比例患者中持续使用了循证疗法并进行了额外的冠状动脉手术，但仍出现了这些结果。GRACE风险评分在医院幸存者中预测长期死亡率的判别准确性得以维持。
