急性心肌梗死：FAST-MI 项目（1995 年至 2015 年法国急性 ST 段抬高或非 ST 段抬高心肌梗死注册研究）20 年来患者特征、治疗方法的变化和 6 个月预后
Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015.
机构信息
Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology; Université Paris-Descartes, Paris, France; INSERM U-970, France (E.P., N.A., N.D.).
AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, France (T.S.).
出版信息
Circulation. 2017 Nov 14;136(20):1908-1919. doi: 10.1161/CIRCULATIONAHA.117.030798. Epub 2017 Aug 27.
BACKGROUND
ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015.
METHODS
We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France.
RESULTS
From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention.
CONCLUSIONS
Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.
背景
ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）的治疗在过去 20 年中发生了重大变化。关于最近几年死亡率趋势的信息很少。我们评估了 1995 年至 2015 年法国急性心肌梗死的特征、治疗和结局的趋势。
方法
我们使用了 1995 年至 2015 年 5 年间每 5 年进行一次的 5 个为期 1 个月的登记数据，包括法国大都市地区心脏重症监护病房收治的 14423 例急性心肌梗死患者（59%为 STEMI）。
结果
1995 年至 2015 年，STEMI 患者的平均年龄从 66±14 岁降至 63±14 岁；NSTEMI 患者的年龄保持稳定（68±14 岁），而糖尿病、肥胖和高血压的比例增加。在急性期，STEMI 患者的初始经皮冠状动脉介入治疗率从 12%（1995 年）增加到 76%（2015 年）。NSTEMI 患者的发病 72 小时内行经皮冠状动脉介入治疗的比例从 9%（1995 年）增加到 60%（2015 年）。STEMI 患者的 6 个月死亡率从 1995 年的 17.2%持续下降到 2010 年的 6.9%和 2015 年的 5.3%；NSTEMI 患者的死亡率从 17.2%下降到 2010 年的 6.9%和 2015 年的 6.3%。STEMI 患者如果没有接受再灌注治疗，2010 年后死亡率仍在下降，而 STEMI 患者如果接受了再灌注治疗或接受了经皮冠状动脉介入治疗，无论是否接受了经皮冠状动脉介入治疗，NSTEMI 患者的死亡率都没有进一步下降。
结论
在过去的 20 年中，STEMI 和 NSTEMI 患者的急性心肌梗死后 6 个月死亡率大幅下降。STEMI 患者的死亡率持续下降到 2015 年，而 NSTEMI 患者的死亡率自 2010 年以来似乎保持稳定。
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