接受直接经皮冠状动脉介入治疗的ST段抬高型急性心肌梗死患者长期死亡的心脏和非心脏原因
Cardiac and Noncardiac Causes of Long-Term Mortality in ST-Segment-Elevation Acute Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention.
作者信息
Yamashita Yugo, Shiomi Hiroki, Morimoto Takeshi, Yaku Hidenori, Furukawa Yutaka, Nakagawa Yoshihisa, Ando Kenji, Kadota Kazushige, Abe Mitsuru, Nagao Kazuya, Shizuta Satoshi, Ono Koh, Kimura Takeshi
机构信息
From the Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Y.Y., H.S., H.Y., S.S., K.O., T.K.), Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Tenri, Japan (Y.N.); Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.A.); Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan (K.K.); Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (M.A.); and Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan (K.N.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1). doi: 10.1161/CIRCOUTCOMES.116.002790.
BACKGROUND
In patients with ST-segment-elevation acute myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention, long-term risks for cardiac and noncardiac death beyond acute phase of STEMI have not been thoroughly evaluated yet.
METHODS AND RESULTS
We identified 3942 STEMI patients who had primary percutaneous coronary intervention within 24 hours after onset between January 2005 and December 2007 in the CREDO-Kyoto AMI registry (Coronary Revascularization Demonstrating Outcome study in Kyoto Acute Myocardial Infarction) and evaluated their short-term (within 6-month) and long-term (beyond 6-month) incidences and causes of deaths. The cumulative 5-year incidence of all-cause death in the current study population was 20.4% (cardiac death, 12.2% and noncardiac death, 9.4%, respectively). The vast majority of deaths were cardiac in origin within 6-month (cardiac death, 8.0% and noncardiac death, 0.9%), whereas noncardiac death accounted for nearly two thirds of all-cause death beyond 6-month (cardiac death, 4.6% and noncardiac death, 8.5%). In the stratified analysis according to age, the proportion of noncardiac death was similar regardless of age although the absolute mortality rate was higher with increasing age. By the multivariable Cox regression models, the independent risk factors of all-cause death were advanced age, cardiogenic shock, renal dysfunction, large infarct size, and anterior wall infarction within 6 months after STEMI, and advanced age, previous heart failure, renal dysfunction, and liver cirrhosis beyond 6 months after STEMI, respectively.
CONCLUSIONS
In STEMI patients who underwent primary percutaneous coronary intervention, the long-term risk for cardiac death was relatively low compared with that for noncardiac death, which accounted for nearly two thirds of all-cause death beyond 6 months.
背景
在接受直接经皮冠状动脉介入治疗的ST段抬高型急性心肌梗死（STEMI）患者中，STEMI急性期后心脏和非心脏死亡的长期风险尚未得到充分评估。
方法与结果
我们在CREDO-Kyoto AMI注册研究（京都急性心肌梗死冠状动脉血运重建疗效研究）中，确定了2005年1月至2007年12月期间发病后24小时内接受直接经皮冠状动脉介入治疗的3942例STEMI患者，并评估了他们短期（6个月内）和长期（6个月后）的死亡发生率及原因。本研究人群中全因死亡的累积5年发生率为20.4%（心脏死亡12.2%，非心脏死亡9.4%）。绝大多数死亡在6个月内源于心脏原因（心脏死亡8.0%，非心脏死亡0.9%），而6个月后非心脏死亡占全因死亡的近三分之二（心脏死亡4.6%，非心脏死亡8.5%）。在按年龄分层分析中，无论年龄大小，非心脏死亡的比例相似，尽管绝对死亡率随年龄增长而升高。通过多变量Cox回归模型，STEMI后6个月内全因死亡的独立危险因素分别为高龄、心源性休克、肾功能不全、梗死面积大及前壁梗死，STEMI后6个月以上全因死亡的独立危险因素分别为高龄、既往心力衰竭、肾功能不全及肝硬化。
结论
在接受直接经皮冠状动脉介入治疗的STEMI患者中，与非心脏死亡相比，心脏死亡的长期风险相对较低，非心脏死亡占6个月后全因死亡的近三分之二。
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