Wita Krystian, Kułach Andrzej, Sikora Jacek, Fluder Joanna, Nowalany-Kozielska Ewa, Milewski Krzysztof, Pączek Piotr, Sobocik Henryk, Olender Jacek, Szela Lucjan, Kalarus Zbigniew, Buszman Pawel, Jankowski Piotr, Gąsior Mariusz
First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland.
Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland.
J Clin Med. 2020 Sep 30;9(10):3178. doi: 10.3390/jcm9103178.
Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland's National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up.
MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression.
MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42-0.65, < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction.
Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.
急性心肌梗死（AMI）急性治疗方面的进展大幅降低了住院死亡率，但出院后的预后仍不尽人意。急性心肌梗死管理式医疗（MC-AMI）是波兰国家卫生基金的一个项目，旨在提供全面的AMI后护理以改善长期预后。本研究的目的是评估MC-AMI在一年随访期内对全因死亡率的影响。
MC-AMI包括急性心肌梗死治疗、复杂血运重建、心脏康复（CR）、为期一年的定期门诊随访以及预防心源性猝死。在波兰西里西亚省进行的这项回顾性观察研究中，我们分析了3893名MC-AMI参与者，并将他们与对照组的6946名患者进行比较。在倾向得分匹配后，我们比较了每组3551名受试者的两组情况。为了评估MC-AMI和其他变量对死亡率的影响，我们进行了Cox回归分析。
在12个月的观察期内，MC-AMI与死亡率降低38%相关，且该效果在之后依然持续。多变量Cox回归分析显示，参与MC-AMI与1年死亡率呈负相关（风险比0.52，95%置信区间0.42 - 0.65，P < 0.001）。除此之外，年龄较大（每增加10岁风险比1.47）、ST段抬高型AMI（风险比1.41）、心力衰竭（风险比2.08）、糖尿病（风险比1.52）和透析（风险比2.38）与主要终点显著相关。在MC-AMI的组成部分中，心脏康复（风险比0.34）和严格的门诊护理（风险比0.42）是影响死亡率降低的关键因素。
参与MC-AMI可使1年死亡率降低38%，且在项目完成后该效果依然持续。
