Greco Cesare, Rosato Stefano, D'Errigo Paola, Mureddu Gian Francesco, Lacorte Eleonora, Seccareccia Fulvia
Division of Cardiology, San Giovanni Hospital, Rome, Italy.
Istituto Superiore di Sanità, Rome, Italy.
Int J Cardiol. 2015 Apr 1;184:115-121. doi: 10.1016/j.ijcard.2015.01.073. Epub 2015 Jan 28.
Uncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI.
Our aim was to appraise both the early prognosis and prognosis at 1-year after discharge of patients hospitalized due to AMI.
This is a retrospective nationwide cohort study based on data from an administrative database on patients admitted with AMI from 2001 to 2011 in all Italian hospitals sites. Mortality and readmission rates within 30 days, 60 days and 1 year were calculated, as well as re-hospitalizations for all causes and for HF.
A total of 1,110,822 patients were included. Index admission mortality rate (I-MR) and total in-hospital mortality rate (T-MR) at up to 1 year both decreased respectively from 11.34% to 8.99% and from 16.46% to 14.68% in the years 2001 to 2011 (both p<0.0001), while fatal readmission rate (F-RR) at 1 year increased from 4.75% to 5.28% (p=0.0019). Patients that developed HF during the index admission had significantly higher I-MR and F-RR. I-MR, F-RR, and T-MR, however, remained low at any time point considered (30 days, 60 days and 1 year) in a subgroup of low-risk optimally-treated patients.
The risk of fatal readmission at 1 year increased slightly over time, in spite of the remarkable improvements currently achieved in overall prognosis after AMI. The identification of patients at high risk (mainly due to HF complicating AMI), and of patients at low risk is crucial to define and support management strategies.
尽管急性心肌梗死（AMI）患者的管理不断取得进展，但AMI后长期预后仍存在不确定性。
我们的目的是评估因AMI住院患者出院后1年的早期预后和预后情况。
这是一项基于意大利所有医院2001年至2011年AMI住院患者行政数据库数据的全国性回顾性队列研究。计算了30天、60天和1年内的死亡率和再入院率，以及所有原因和心力衰竭导致的再次住院率。
共纳入1110822例患者。2001年至2011年，指数入院死亡率（I-MR）和1年内总住院死亡率（T-MR）分别从11.34%降至8.99%，从16.46%降至14.68%（均p<0.0001），而1年时的致命再入院率（F-RR）从4.75%升至5.28%（p=0.0019）。在指数入院期间发生心力衰竭的患者I-MR和F-RR显著更高。然而，在低风险最佳治疗的亚组患者中，在任何考虑的时间点（30天、60天和1年），I-MR、F-RR和T-MR仍然较低。
尽管目前AMI后的总体预后有显著改善，但1年时致命再入院的风险随时间略有增加。识别高危患者（主要是由于AMI并发心力衰竭）和低危患者对于确定和支持管理策略至关重要。
