急性心肌梗死后不稳定型心绞痛再住院及非计划血管重建的临床相关性

Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction.

作者信息

Shore Supriya, Smolderen Kim G, Spertus John A, Kennedy Kevin F, Jones Philip G, Zhao Zhenxiang, Wang Tracy Y, Arnold Suzanne V

机构信息

Emory University School of Medicine, Atlanta, GA

Ghent University, Ghent, Belgium Mid America Heart Institute, Kansas City, MO University of Missouri Kansas City, Kansas City, MO.

出版信息

J Am Heart Assoc. 2016 Aug 20;5(8):e003129. doi: 10.1161/JAHA.115.003129.

DOI:10.1161/JAHA.115.003129

PMID:27543798

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5015270/

Abstract

BACKGROUND

Rehospitalizations following acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are often included as parts of composite end points in clinical trials. Although clearly costly, the clinical relevance of these individual components has not been described.

METHODS AND RESULTS

Patients enrolled in a prospective, 24-center, US acute myocardial infarction registry were followed for 1 year after an acute myocardial infarction for rehospitalizations, that were independently adjudicated by experienced cardiologists. Patients who did and did not experience UA or revascularization rehospitalization were propensity matched using greedy matching. Among 3283 patients with acute myocardial infarction who were included, mean age was 59 years, 33% were female, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 5.0% and 4.1%, respectively. After propensity matching, we included 2433 patients in the UA rehospitalization group and 2410 in the unplanned revascularization group. Using weighted proportional hazards Cox regression, there was no significant association between a rehospitalization for UA and 5-year all-cause mortality (9.6% versus 13.8%; adjusted hazard ratio 0.87, 95% CI 0.60-1.16). Patients rehospitalized for unplanned revascularization had a lower 5-year mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50-0.92) compared with those without such rehospitalizations. Nevertheless, patients with UA and unplanned revascularization had a substantially greater hazard of subsequent rehospitalizations compared with patients without such events (UA: hazard ratio 4.36, 95% CI 3.48-5.47; revascularization: hazard ratio 4.38, 95% CI 3.53-5.44).

CONCLUSIONS

Rehospitalizations for UA and unplanned revascularization in the year after an acute myocardial infarction are associated with higher risks of subsequent rehospitalizations but not with mortality.

摘要

背景

急性心肌梗死后因计划外冠状动脉血运重建和不稳定型心绞痛（UA）而再次住院的情况，在临床试验中常被纳入复合终点的组成部分。尽管费用高昂，但这些个体组成部分的临床相关性尚未得到描述。

方法与结果

纳入一项前瞻性、多中心、美国急性心肌梗死注册研究的患者，在急性心肌梗死后随访1年，观察再次住院情况，由经验丰富的心脏病专家独立判定。对发生和未发生UA或血运重建再次住院的患者，采用贪婪匹配法进行倾向评分匹配。在纳入的3283例急性心肌梗死患者中，平均年龄59岁，33%为女性，70%为白人。1年时UA和计划外血运重建的再次住院率分别为5.0%和4.1%。倾向评分匹配后，UA再次住院组纳入2433例患者，计划外血运重建组纳入2410例患者。使用加权比例风险Cox回归分析，UA再次住院与5年全因死亡率之间无显著关联（9.6%对13.8%；调整后风险比0.87，95%可信区间0.60 - 1.16）。与未进行计划外血运重建再次住院的患者相比，因计划外血运重建再次住院的患者5年死亡风险较低（7.0%对15.1%；风险比0.68，95%可信区间0.50 - 0.92）。然而，与未发生此类事件的患者相比，发生UA和计划外血运重建的患者后续再次住院的风险显著更高（UA：风险比4.36，95%可信区间3.48 - 5.47；血运重建：风险比4.38，95%可信区间3.53 - 5.44）。