Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust, London, UK.
Heart. 2020 May;106(10):765-771. doi: 10.1136/heartjnl-2019-315760. Epub 2019 Nov 15.
International studies report a decline in mortality following ST-elevation myocardial infarction (STEMI). The extent to which the observed improvements in STEMI survival are explained by temporal changes in patient characteristics and utilisation of treatments is unknown.
Cohort study using national registry data from the Myocardial Ischaemia National Audit Project between first January 2004 and 30th June 2013. 232 353 survivors of hospitalisation with STEMI as recorded in 247 hospitals in England and Wales. Flexible parametric survival modelling and causal mediation analysis were used to estimate the relative contribution of temporal changes in treatments and patient characteristics on improved STEMI survival.
Over the study period, unadjusted survival at 6 months and 1 year improved by 0.9% and 1.0% on average per year (HR: 0.991, 95% CI: 0.988 to 0.994 and HR: 0.990, 95% CI: 0.987 to 0.993, respectively). The uptake of primary percutaneous coronary intervention (PCI) (HR: 1.025, 95% CI: 1.021 to 1.028) and increased prescription of P2Y inhibitors (HR: 1.035, 95% CI: 1.031 to 1.039) were significantly associated with improvements in 1-year survival. Primary PCI explained 16.8% (95% CI: 10.8% to 31.6%) and 13.2% (9.2% to 21.9%) of the temporal survival improvements at 6 months and 1 year, respectively, whereas P2Y inhibitor prescription explained 5.3% (3.6% to 8.8%) of the temporal improvements at 6 months but not at 1 year.
For STEMI in England and Wales, improvements in survival between 2004 and 2013 were significantly explained by the uptake of primary PCI and increased use of P2Y inhibitors at 6 months and primary PCI only at 1 year.
NCT03749694.
国际研究报告称，ST 段抬高型心肌梗死（STEMI）后的死亡率有所下降。观察到的 STEMI 生存率的提高在多大程度上可以通过患者特征和治疗方法的时间变化来解释尚不清楚。
使用 2004 年 1 月至 2013 年 6 月 30 日期间全国心肌血运重建项目（Myocardial Ischaemia National Audit Project）的全国登记数据进行队列研究。共纳入英格兰和威尔士 247 家医院记录的 STEMI 住院幸存者 232353 例。采用灵活参数生存模型和因果中介分析估计治疗和患者特征随时间变化对 STEMI 生存率提高的相对贡献。
在研究期间，未经调整的 6 个月和 1 年生存率平均每年提高 0.9%和 1.0%（HR：0.991，95%CI：0.988 至 0.994 和 HR：0.990，95%CI：0.987 至 0.993）。直接经皮冠状动脉介入治疗（PCI）的使用率（HR：1.025，95%CI：1.021 至 1.028）和 P2Y 抑制剂处方的增加（HR：1.035，95%CI：1.031 至 1.039）与 1 年生存率的提高显著相关。直接 PCI 分别解释了 6 个月和 1 年时的 6 个月和 1 年时时间生存改善的 16.8%（95%CI：10.8%至 31.6%）和 13.2%（9.2%至 21.9%），而 P2Y 抑制剂处方仅解释了 6 个月时的 5.3%（3.6%至 8.8%），但 1 年时无统计学意义。
在英格兰和威尔士，2004 年至 2013 年 STEMI 生存率的提高主要归因于直接 PCI 的应用增加和 6 个月时 P2Y 抑制剂使用率的提高，仅在 1 年时归因于直接 PCI。
NCT03749694。
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