根据动脉粥样硬化血栓形成危险分层的急性心肌梗死患者的适当二级预防和临床结局：FAST-MI 2010 注册研究。

Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry.

机构信息

1 Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France.

2 Division of Cardiovascular Medicine, Brigham and Women's Hospital, USA.

出版信息

Eur J Prev Cardiol. 2019 Mar;26(4):411-419. doi: 10.1177/2047487318808638. Epub 2018 Oct 24.

DOI:10.1177/2047487318808638

PMID:30354737

Abstract

BACKGROUND

Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction.

DESIGN

The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction.

METHODS

We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated).

RESULTS

Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59-1.12, p = 0.21) in group 1, 0.74 (0.54-1.01; p = 0.06) in group 2, and 0.64 (0.52-0.79, p < 0.001) in group 3.

CONCLUSIONS

Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

摘要

背景

急性心肌梗死后，通常无法充分开具二级预防药物。

设计

本研究旨在分析根据急性心肌梗死后血栓形成溶栓治疗（TIMI）二级预防风险评分（TRS-2P）定义的风险水平，出院时开具适当的二级预防治疗与长期临床结局之间的关系。

方法

我们使用了来自 2010 年法国急性 ST 段抬高或非 ST 段抬高心肌梗死（FAST-MI）注册中心的数据，包括法国心脏重症监护病房收治的 4169 例连续急性心肌梗死患者。使用 TRS-2P 评分将风险水平分为三组：组 1（低危；TRS-2P=0/1）；组 2（中危；TRS-2P=2）；组 3（高危；TRS-2P≥3）。根据最新指南（所有患者均使用双联抗血小板治疗和中等/大剂量他汀类药物；新的 P2Y12 抑制剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂）定义适当的二级预防治疗。

结果

组 1、2 和 3 的比例分别为 46%、25%和 29%。每组出院时使用适当二级预防治疗的比例分别为 39.5%、37%和 28%。多变量调整后，出院时使用基于证据的治疗与 5 年内主要不良心血管事件（死亡、再心肌梗死或卒中）发生率降低相关，尤其是高危患者：组 1 的风险比为 0.82（95%置信区间：0.59-1.12，p=0.21），组 2 为 0.74（0.54-1.01；p=0.06），组 3 为 0.64（0.52-0.79，p<0.001）。