美国临床实践中治疗老年急性心肌梗死患者的长期死亡率。

Long-Term Mortality of Older Patients With Acute Myocardial Infarction Treated in US Clinical Practice.

机构信息

Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC

Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.

出版信息

J Am Heart Assoc. 2018 Jun 30;7(13):e007230. doi: 10.1161/JAHA.117.007230.

BACKGROUND

There is limited information about the long-term survival of older patients after myocardial infarction (MI).

METHODS AND RESULTS

CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines) was a registry of MI patients treated at 568 US hospitals from 2001 to 2006. We linked MI patients aged ≥65 years in CRUSADE to their Medicare data to ascertain long-term mortality (defined as 8 years post index event). Long-term unadjusted Kaplan-Meier mortality curves were examined among patients stratified by revascularization status. A landmark analysis conditioned on surviving the first year post-MI was conducted. We used multivariable Cox regression to compare mortality risks between ST-segment-elevation myocardial infarction and non-ST-segment-elevation myocardial infarction patients. Among 22 295 MI patients ≥ age 65 years (median age 77 years), we observed high rates of evidence-based medication use at discharge: aspirin 95%, β-blockers 94%, and statins 81%. Despite this, mortality rates were high: 24% at 1 year, 51% at 5 years, and 65% at 8 years. Eight-year mortality remained high among patients who underwent percutaneous coronary intervention (49%), coronary artery bypass graft (46%), and among patients who survived the first year post-MI (59%). Median survival was 4.8 years (25th, 75th percentiles 1.1, 8.5); among patients aged 65-74 years it was 8.2 years (3.3, 8.9) while for patients aged ≥75 years it was 3.1 years (0.6, 7.6). Eight-year mortality was lower among ST-segment-elevation myocardial infarction than non-ST-segment-elevation myocardial infarction patients (53% versus 67%); this difference was not significant after adjustment (hazard ratio 0.94, 95% confidence interval, 0.88-1.00).

CONCLUSIONS

Long-term mortality remains high among patients with MI in routine clinical practice, even among revascularized patients and those who survived the first year.

背景

关于心肌梗死（MI）后老年患者的长期生存情况，相关信息有限。

方法和结果

CRUSADE（不稳定型心绞痛患者快速危险分层能否通过早期实施 ACC/AHA 指南来降低不良结局）是一项 2001 年至 2006 年在美国 568 家医院治疗的 MI 患者注册研究。我们将 CRUSADE 中年龄≥65 岁的 MI 患者与他们的医疗保险数据相联系，以确定长期死亡率（定义为索引事件后 8 年）。根据血管重建状态对患者进行分层，检查长期未经调整的 Kaplan-Meier 死亡率曲线。对 MI 后存活满 1 年的患者进行了一个基于时间的分析。我们使用多变量 Cox 回归比较 ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死患者的死亡率风险。在 22295 名年龄≥65 岁的 MI 患者（中位年龄 77 岁）中，我们观察到出院时使用循证药物的比例很高：阿司匹林 95%、β受体阻滞剂 94%和他汀类药物 81%。尽管如此，死亡率仍然很高：1 年时为 24%，5 年时为 51%，8 年时为 65%。接受经皮冠状动脉介入治疗（49%）、冠状动脉旁路移植术（46%）和 MI 后存活满 1 年的患者（59%）8 年死亡率仍然很高。中位生存时间为 4.8 年（25%，75%分位数 1.1，8.5）；年龄在 65-74 岁的患者为 8.2 年（3.3，8.9），而年龄≥75 岁的患者为 3.1 年（0.6，7.6）。ST 段抬高型心肌梗死患者的 8 年死亡率低于非 ST 段抬高型心肌梗死患者（53%比 67%）；但调整后差异无统计学意义（风险比 0.94，95%置信区间，0.88-1.00）。