Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Clin Lipidol. 2020 Mar-Apr;14(2):260-270. doi: 10.1016/j.jacl.2020.01.004. Epub 2020 Jan 23.
High-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and antiplatelet agents (ie, intensive medical management) reduce coronary heart disease (CHD) risk after myocardial infarction (MI).
The objective of the study was to determine the risk of CHD events or death despite receiving intensive medical management after MI.
We studied 16,853 United States adults with health insurance in the MarketScan and Medicare databases who underwent percutaneous coronary intervention while hospitalized for MI between January 1, 2014 and June 30, 2015 and received intensive medical management within 30 days after hospital discharge. MI, CHD, and all-cause mortality rates from 30 days after hospital discharge through December 31, 2015 were compared with 67,412 individuals in each of three groups: (1) the general MarketScan and Medicare populations, (2) with diabetes, and (3) with a CHD history.
Among beneficiaries intensively medically managed after their MI, recurrent MI, CHD events, and all-cause mortality rates were 47.1, 72.0, and 57.5 per 1000 person-years, respectively. The multivariable-adjusted hazard ratio (95% CI) comparing intensively medically managed beneficiaries after MI to the general population, those with diabetes, and those with a history of CHD were 8.54 (7.52-9.70), 7.40 (6.61-8.28), and 5.45 (4.92-6.05), respectively, for recurrent MI; 7.82 (7.07-8.64), 6.27 (5.74-6.86), and 4.45 (4.10-4.82), respectively, for CHD events; and 1.15 (1.05-1.25), 1.05 (0.97-1.14), and 1.06 (0.97-1.15), respectively, for all-cause mortality.
Substantial residual risk for MI and CHD events remains despite intensive medical management after MI.
高强度他汀类药物、β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和抗血小板药物（即强化药物治疗）可降低心肌梗死后的冠心病（CHD）风险。
本研究旨在确定心肌梗死后接受强化药物治疗后发生 CHD 事件或死亡的风险。
我们研究了 MarketScan 和 Medicare 数据库中 16853 名美国成年人，他们在 2014 年 1 月 1 日至 2015 年 6 月 30 日期间因心肌梗住院，并在出院后 30 天内接受强化药物治疗。比较了出院后 30 天至 2015 年 12 月 31 日的 MI、CHD 和全因死亡率，与以下三组各 67412 名个体进行比较：（1）普通 MarketScan 和 Medicare 人群，（2）患有糖尿病，（3）有 CHD 病史。
在 MI 后接受强化药物治疗的患者中，复发性 MI、CHD 事件和全因死亡率分别为 47.1、72.0 和 57.5/1000 人年。多变量调整后的风险比（95%CI）将 MI 后接受强化药物治疗的患者与普通人群、糖尿病患者和 CHD 病史患者进行比较，复发性 MI 分别为 8.54（7.52-9.70）、7.40（6.61-8.28）和 5.45（4.92-6.05），CHD 事件分别为 7.82（7.07-8.64）、6.27（5.74-6.86）和 4.45（4.10-4.82），全因死亡率分别为 1.15（1.05-1.25）、1.05（0.97-1.14）和 1.06（0.97-1.15）。
尽管 MI 后接受强化药物治疗，但 MI 和 CHD 事件仍存在大量残余风险。
