Puymirat Etienne, Aissaoui Nadia, Lemesle Gilles, Cottin Yves, Coste Pierre, Schiele François, Ferrières Jean, Simon Tabassome, Danchin Nicolas
Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France; INSERM U-970, Paris, France.
Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Paris, France.
Am J Cardiol. 2017 Mar 1;119(5):692-697. doi: 10.1016/j.amjcard.2016.11.032. Epub 2016 Dec 2.
The prognosis of patients with acute myocardial infarction (AMI) has notably improved in the past 20 years. Using the French Registry of ST-Elevation and Non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated whether previous manifestations of atherosclerotic disease (i.e., previous MI, or a history of any form of atherosclerotic disease) are at truly increased risk compared with those in whom AMI is the first manifestation of the disease. FAST-MI 2010 is a nationwide French registry including 3,079 patients with AMI, among whom 1,062 patients had a history of cardiovascular atherosclerotic disease and 498 patients had a history of MI. Overall, patients with a history of atherosclerotic disease (or MI) were older compared with patients without known cardiovascular disease (71 ± 13 vs 63 ± 14 years) and had higher cardiovascular risk profiles and co-morbidities. Using fully adjusted Cox multivariate analysis, previous manifestations of atherosclerotic disease were associated with higher 3-year mortality (hazard ratio 1.80, 95% confidence interval 1.40 to 2.31; p <0.001) as history of previous MI alone (hazard ratio 1.32, 95% confidence interval 1.00 to 1.73; p = 0.048). Similar results were found in patients discharged alive. In conclusion, previous cardiovascular atherosclerotic disease represents 1/3 of patients with AMI and are strongly associated with worse long-term clinical outcomes. Intensive follow-up and therapy should be encouraged in this high-risk population.
在过去20年中，急性心肌梗死（AMI）患者的预后有了显著改善。我们利用法国ST段抬高型和非ST段抬高型心肌梗死注册研究（FAST-MI）2010注册库，调查与AMI为疾病首发表现的患者相比，动脉粥样硬化疾病既往表现（即既往心肌梗死或任何形式动脉粥样硬化疾病史）的患者是否真的有更高风险。FAST-MI 2010是一项法国全国性注册研究，纳入3079例AMI患者，其中1062例患者有心血管动脉粥样硬化疾病史，498例患者有心肌梗死病史。总体而言，有动脉粥样硬化疾病（或心肌梗死）史的患者比无已知心血管疾病的患者年龄更大（71±13岁对63±14岁），且有更高的心血管风险特征和合并症。使用完全调整的Cox多变量分析，动脉粥样硬化疾病的既往表现与3年更高死亡率相关（风险比1.80，95%置信区间1.40至2.31；p<0.001），单独既往心肌梗死史亦是如此（风险比1.32，95%置信区间1.00至1.73；p = 0.048）。在存活出院的患者中也发现了类似结果。总之，既往心血管动脉粥样硬化疾病占AMI患者的三分之一，且与更差的长期临床结局密切相关。应鼓励对这一高危人群进行强化随访和治疗。
