Bucholz Emily M, Butala Neel M, Normand Sharon-Lise T, Wang Yun, Krumholz Harlan M
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut.
Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
J Am Coll Cardiol. 2016 May 24;67(20):2378-2391. doi: 10.1016/j.jacc.2016.03.507.
Guideline-based admission therapies for acute myocardial infarction (AMI) significantly improve 30-day survival, but little is known about their association with long-term outcomes.
This study evaluated the association of 5 AMI admission therapies (aspirin, beta-blockers, acute reperfusion therapy, door-to-balloon [D2B] time ≤90 min, and time to fibrinolysis ≤30 min) with life expectancy and years of life saved after AMI.
We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for AMI, with 17 years of follow-up. Life expectancy and years of life saved after AMI were calculated using Cox proportional hazards regression with extrapolation using exponential models.
Survival for recipients and non-recipients of the 5 guideline-based therapies diverged early after admission and continued to diverge during 17-year follow-up. Receipt of aspirin, beta-blockers, and acute reperfusion therapy on admission was associated with longer life expectancy of 0.78 (standard error [SE]: 0.05), 0.55 (SE: 0.06), and 1.03 (SE: 0.12) years, respectively. Patients receiving primary percutaneous coronary intervention (PCI) within 90 min lived 1.08 (SE: 0.49) years longer than patients with D2B times >90 min, and door-to-needle (D2N) times ≤30 min were associated with 0.55 (SE: 0.12) more years of life. A dose-response relationship was observed between longer D2B and D2N times and shorter life expectancy after AMI.
Guideline-based therapy for AMI admission is associated with both early and late survival benefits, and results in meaningful gains in life expectancy and large numbers of years of life saved in elderly patients.
基于指南的急性心肌梗死（AMI）入院治疗可显著提高30天生存率，但对于其与长期预后的关联知之甚少。
本研究评估了5种AMI入院治疗（阿司匹林、β受体阻滞剂、急性再灌注治疗、门球时间≤90分钟以及溶栓时间≤30分钟）与AMI后预期寿命和挽救生命年数的关联。
我们分析了合作心血管项目的数据，该项目是一项针对因AMI住院的医疗保险受益人的研究，随访时间为17年。使用Cox比例风险回归并采用指数模型进行外推，计算AMI后的预期寿命和挽救生命年数。
接受5种基于指南治疗的患者与未接受治疗的患者在入院后早期生存率就出现差异，并且在17年的随访期间持续存在差异。入院时接受阿司匹林、β受体阻滞剂和急性再灌注治疗分别与预期寿命延长0.78年（标准误[SE]：0.05）、0.55年（SE：0.06）和1.03年（SE：0.12）相关。90分钟内接受直接经皮冠状动脉介入治疗（PCI）的患者比门球时间>90分钟的患者寿命长1.08年（SE：0.49），门针时间≤30分钟与多挽救0.55年（SE：0.12）的生命相关。AMI后，门球时间和门针时间越长，预期寿命越短，呈现剂量反应关系。
基于指南的AMI入院治疗与早期和晚期生存获益均相关，可使老年患者的预期寿命显著延长，并挽救大量生命年数。
