Department of Cardiology, Falun Hospital, Sweden Department of Medical Sciences, Uppsala University, Sweden
Department of Cardiology, Skane University Hospital, Sweden.
Eur J Prev Cardiol. 2016 Mar;23(4):340-8. doi: 10.1177/2047487315585293. Epub 2015 May 18.
While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort.
We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders.
Lipid control (LDL-cholesterol <2.5 mmol/L) improved from 67.9% to 71.1% (p = 0.016) over time, achieved by 67.9% vs 63.3%, p < 0.001 of men vs women. Blood pressure control (<140 mmHg systolic) increased over time (59.1% vs 69.5%, p < 0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p < 0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14-1.32) for women vs men and 0.94 (95% CI 0.92-0.96) for the 2012 vs the 2005 cohort.
Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.
尽管二级预防可改善急性心肌梗死（AMI）后的预后，但先前的研究表明，指南的遵循情况并不理想，且随着时间的推移并未得到改善，同时存在性别差异。本研究提供了来自大型全国队列的最新数据。
我们在瑞典 Web 系统中确定了 51620 名年龄<75 岁的患者，这些患者在 AMI 后两个月和/或十二个月进行了检查，以评估根据推荐疗法评估的心脏病增强和发展的证据（SWEDEHEART）。比较了 2005 年和 2012 年两个队列以及不同性别之间一年时的危险因素控制和再入院情况。
血脂控制（LDL-胆固醇<2.5mmol/L）随时间从 67.9%增加到 71.1%（p=0.016），男性达到 67.9%，而女性为 63.3%，p<0.001。血压控制（收缩压<140mmHg）随时间增加（2005 年和 2012 年队列中分别为 59.1%和 69.5%，p<0.001），且男性的控制效果更好（66.4%和 61.9%，p<0.001）。戒烟率为 55.6%，且无性别差异或随时间变化。女性的心脏再入院率为 18.2%，男性为 15.5%，从 2005 年到 2012 年有所下降（分别为 20.8%和 14.9%）。调整后的比值比为女性与男性相比为 1.22（95%CI 1.14-1.32），与 2005 年相比，2012 年的比值比为 0.94（95%CI 0.92-0.96）。
尽管本研究在 AMI 后危险因素控制的先前研究中表现良好，但随着时间的推移，血压方面的改善更为明显，这表明仍有很大的预防潜力。需要进一步分析导致危险因素控制和再入院方面出现性别差异的原因。
