Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey.
Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey.
Am J Cardiol. 2018 Jul 1;122(1):1-5. doi: 10.1016/j.amjcard.2018.03.005. Epub 2018 Mar 28.
Patients who develop heart failure (HF) after an acute myocardial infarction (AMI) are at higher risk of adverse fatal and nonfatal outcomes. Published studies on the incidence and associations of HF after infarction have been contradictory, with some reporting increasing and others decreasing incidence. Between 2000 and 2015, 109,717 patients admitted for a first AMI in New Jersey were discharged alive. In the 15 years from 2000 to 2015, the rates of admission for HF in AMI patients who were discharged alive decreased by 60%, from 3.48% to 1.4%, at 1-year follow-up. At 5 years of follow-up, the decline was more pronounced, from 7.21% to 1.4%, an 80% decline. All-cause death, and the combined end point of admission for HF or death, showed decreasing trends. Cox regression indicated a decrease in the risk of admission for HF over time (hazard ratio [HR] 0.955, 95% confidence interval [CI] 0.949 to 0.961). Younger age, male gender, and commercial insurance were associated with lower HRs for HF (p <0.001), whereas history of hypertension, diabetes, kidney, or lung disease were associated with higher HRs (p <0.001). There was no significant difference in the rate of HF between subendocardial and transmural AMI (adjusted OR was 0.96, CI 0.90 to 1.03, p = 0.241). Revascularization was associated with a marked decrease in HF admissions (adjusted OR 0.22, 95% CI 0.19 to 0.25, p <0.001 for percutaneous coronary intervention and OR 0.44, 95% CI 0.38 to 0.51, p <0.001 for CABG). In conclusion, the rate of admission for HF after discharge for a first myocardial infarction as well as all-cause death decreased markedly from 2000 to 2015.
在急性心肌梗死（AMI）后发生心力衰竭（HF）的患者具有更高的不良致死和非致死结局风险。关于梗死后 HF 的发生率和相关性的已发表研究结果相互矛盾，有些研究报告发病率增加，而有些研究报告发病率降低。在新泽西州，2000 年至 2015 年间，有 109717 名首次因 AMI 入院的患者存活出院。在 2000 年至 2015 年的 15 年中，在存活出院的 AMI 患者中，HF 的住院率从 3.48%降至 1.4%，在 1 年随访时下降了 60%。在 5 年随访时，下降更为明显，从 7.21%降至 1.4%，下降了 80%。全因死亡和 HF 入院或死亡的联合终点均呈下降趋势。Cox 回归表明 HF 的入院风险随时间呈下降趋势（风险比 [HR]0.955，95%置信区间 [CI]0.949 至 0.961）。年龄较小、男性和商业保险与较低的 HF 风险 HR 相关（p<0.001），而高血压、糖尿病、肾脏或肺部疾病病史与较高的 HR 相关（p<0.001）。心内膜下和透壁性 AMI 之间的 HF 发生率无显著差异（调整后比值比为 0.96，CI 为 0.90 至 1.03，p=0.241）。血运重建与 HF 入院率显著降低相关（调整后比值比为 0.22，95%CI 为 0.19 至 0.25，p<0.001 为经皮冠状动脉介入治疗，比值比为 0.44，95%CI 为 0.38 至 0.51，p<0.001 为 CABG）。总之，2000 年至 2015 年，首次心肌梗死后因 HF 出院的住院率以及全因死亡率显著下降。
