Brieger David, Pocock Stuart J, Blankenberg Stefan, Chen Ji Yan, Cohen Mauricio G, Granger Christopher B, Grieve Richard, Nicolau Jose C, Simon Tabassome, Westermann Dirk, Yasuda Satoshi, Gregson John, Rennie Kirsten L, Hedman Katarina, Sundell Karolina Andersson, Goodman Shaun G
Concord Hospital and University of Sydney, Sydney, Australia.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Int J Cardiol. 2020 Jul 15;311:7-14. doi: 10.1016/j.ijcard.2020.01.070. Epub 2020 Jan 28.
Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI).
The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35).
In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options.
对于心肌梗死（MI）后存活一年的未经过筛选的患者的长期预后，目前缺乏相关证据。
TIGRIS（心肌梗死后患者稳定冠状动脉疾病的长期风险、临床管理和医疗资源利用）前瞻性注册研究纳入了来自25个国家的9176例年龄≥50岁、心肌梗死后1 - 3年的符合条件的患者。所有患者都有≥1个风险因素：年龄≥65岁、糖尿病、既往第二次心肌梗死、多支冠状动脉疾病、慢性肾脏病（CKD）。主要结局是在2年随访时发生心肌梗死、伴有紧急血运重建的不稳定型心绞痛、中风或全因死亡的复合事件。还记录了需要住院治疗的出血情况。9027例患者（98.4%）提供了随访数据：主要结局发生在621例（7.0%）患者中，全因死亡率为295例（3.3%），出血发生在109例（1.2%）患者中。事件随时间呈线性累积。在多变量分析中，符合条件的风险因素与主要结局风险增加相关（每100患者年的发病率比[RR][95%置信区间]）：慢性肾脏病2.06（1.66，2.55），既往第二次心肌梗死1.71（1.38，2.10），糖尿病1.63（1.39，1.92），年龄≥65岁1.53（1.28，1.83），多支血管疾病1.24（1.05，1.48）。老年患者（与<65岁相比）发生出血事件的风险更高，65 - 74岁为2.68（1.53，4.70），≥75岁为4.62（2.57，8.28），慢性肾脏病患者为1.99（1.18，3.35）。
在心肌梗死后1 - 3年招募的稳定患者中，复发性心血管和出血事件在2年内呈线性累积。确定了独立预测缺血和出血事件的因素，为决定治疗方案提供了依据。
