Escofet Peris Marina, Alzamora Maria Teresa, Valverde Marta, Fores Rosa, Pera Guillem, Baena-Díez Jose Miguel, Toran Pere
Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain.
Masnou Primary Healthcare Centre, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08320 Barcelona, Spain.
J Clin Med. 2020 Dec 16;9(12):4064. doi: 10.3390/jcm9124064.
Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI).
The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk.
Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9.
In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.
心血管事件是全球范围内死亡和发病的主要原因。首次心血管事件后复发的风险在国际文献中已有记载，尽管在地中海地区低心血管风险的人群队列中的研究并不广泛。关于首次事件后中风和心肌梗死（MI）的复发以及与此类复发相关的因素，包括病理性踝臂指数（ABI）的作用，也有大量研究，尽管结果相互矛盾。
外周动脉ARTPER研究旨在加深我们对在地中海地区初级保健中心接受治疗的低心血管风险人群首次心血管事件后患者病情演变的了解。我们研究总体复发情况、心脏和脑部复发情况。我们对ARTPER前瞻性观察队列中的参与者进行了研究，排除了无心血管事件或事件未得到证实的患者，以及基线时出现动脉钙化或死亡的患者。我们总共分析了520名至少发生过一次心血管事件的患者，重点关注复发的存在和类型、与复发相关的风险因素以及踝臂指数（ABI）作为风险预测指标的表现。
在2006年至2017年期间，46%的首次发生心血管事件的患者经历了某种类型的复发；大多数复发与首次事件属于同一类别。心肌梗死后复发的风险高于中风后。在我们的研究中，复发风险随着年龄、外周动脉疾病（PAD）、糖尿病的存在以及抗血小板药物的使用而增加。糖尿病与所有类型的复发都有关联。此外，ABI<0.9的患者比ABI≥0.9的患者复发次数更多。
简而言之，心脏事件后，复发通常表现为另一次心脏事件。然而，中风后，再次中风或发生心脏事件的几率相似。最后，ABI<0.9可被视为复发风险的预测指标。
