Li Suying, Peng Yi, Wang Xinyue, Qian Yi, Xiang Pin, Wade Sally W, Guo Haifeng, Lopez J Antonio G, Herzog Charles A, Handelsman Yehuda
Hennepin Healthcare Research Institute, Chronic Disease Research Group, Minneapolis, Minnesota.
Amgen Inc., Thousand Oaks, California.
Clin Cardiol. 2019 Mar;42(3):391-399. doi: 10.1002/clc.23160. Epub 2019 Feb 25.
Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events.
Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk.
Two cohorts were studied in a retrospective Medicare 20% random sample-a 2008 cohort with up to 6 years of follow-up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of follow-up (MI, N = 26 548; IS, N = 17 728).
In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient-years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort.
In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high-risk patients, particularly those with diabetes.
心肌梗死（MI）或缺血性中风（IS）幸存者发生后续心血管事件的风险很高。
既往有MI或IS的老年患者有发生心血管事件复发的风险，而糖尿病等合并症可能会增加这种风险。
在一项回顾性医疗保险20%随机样本中研究了两个队列——一个2008年队列，随访时间长达6年（MI，N = 26460；IS，N = 17566），以及一个2012年队列，随访1年（MI，N = 26548；IS，N = 17728）。
在经历过MI或IS事件后存活的老年患者（2012年队列）中，第一年有7.2%发生复发性MI，6.7%发生复发性IS；32%死亡。考虑到多次复发事件（2012年队列），MI队列和IS队列每100患者年的事件发生率分别为11.6和10.2。复发的累积发生率（2008年队列），复发性MI从1年时的7.7%增加到6年时的14.3%，复发性IS从1年时的6.7%增加到6年时的13.4%。合并糖尿病（2012年队列）与MI队列中的MI复发（调整风险比为1.44）和冠状动脉血运重建风险（1.23）以及IS队列中的IS复发（1.26）显著相关。
在这个既往有MI或IS的老年人群中，观察到心血管事件复发率和多次复发事件发生率很高。这些发现凸显了对高危患者，尤其是糖尿病患者进行积极干预以进行二级预防和合并症管理的必要性。
