Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, 141 86 Stockholm, Sweden
AstraZeneca NordicBaltic, Södertälje, Sweden.
Eur Heart J. 2015 May 14;36(19):1163-70. doi: 10.1093/eurheartj/ehu505. Epub 2015 Jan 13.
Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.
This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.
Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.
心肌梗死（MI）后长期疾病进展情况尚不清楚。我们研究了瑞典 MI 出院后患者随后发生心血管事件的风险。
这是一项回顾性队列研究，将瑞典国家登记处的发病率、死亡率和药物治疗数据进行了关联。2006 年 7 月 1 日至 2011 年 6 月 30 日期间，共有 108315 例因初次 MI 住院（索引 MI），其中 97254 例（89.8%）在出院后 1 周内存活并纳入本研究。首次评估非致死性 MI、非致死性卒中和心血管死亡的复合主要终点风险的时间为索引 MI 后 365 天内，研究完成时间为第 366 天。通过 Kaplan-Meier 分析和 Cox 比例风险模型分别评估风险和风险因素。索引 MI 后 365 天内复合终点风险为 18.3%。年龄[60-69 岁 vs. <60 岁：HR（95%CI）：1.37（1.30-1.45）；70-79 岁 vs. <60 岁：2.13（2.03-2.24）；>80 岁 vs. <60 岁：3.96（3.78-4.15）]、既往 MI[1.44（1.40-1.49）]、卒[1.49（1.44-1.54）]、糖尿病[1.37（1.34-1.40）]、心力衰竭[1.57（1.53-1.62）]和无索引 MI 血运重建[1.88（1.83-1.93）]与缺血事件或死亡风险升高均相关。对于在 365 天内未发生复合终点事件的患者，在接下来的 36 个月内，复合终点风险为 20.0%。
MI 后 1 年内心血管事件风险似乎仍然较高，表明需要进行长期监测，尤其是在具有其他危险因素的患者中。
