澳大利亚和新西兰 2009-2015 年急性心肌梗死的长期生存情况：一项基于人群的队列研究。

Long term survival after acute myocardial infarction in Australia and New Zealand, 2009-2015: a population cohort study.

机构信息

Flinders University, Adelaide, SA.

Data to Decisions CRC, Adelaide, SA.

出版信息

Med J Aust. 2021 Jun;214(11):519-525. doi: 10.5694/mja2.51085. Epub 2021 May 16.

DOI:10.5694/mja2.51085

PMID:33997979

Abstract

OBJECTIVE

To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand.

DESIGN

Cohort study.

SETTING, PARTICIPANTS: All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015.

MAIN OUTCOME MEASURE

All-cause mortality up to seven years after an AMI.

RESULTS

239 402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154 287 were men (64.5%), and 64 335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120 155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia.

CONCLUSION

AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor.

摘要

目的

评估澳大利亚和新西兰急性心肌梗死（AMI）后长期生存情况和与生存相关的患者特征。

设计

队列研究。

地点、参与者：2009-2015 年期间，澳大利亚和新西兰所有公立和大多数私立医院收治的所有因 AMI（ICD-10-AM 代码 I21.0-I21.4）入院的患者。

主要结局测量指标

AMI 后 7 年内的全因死亡率。

结果

共确定 239402 例初始 AMI 住院患者；患者平均年龄为 69.3 岁（标准差，14.3 岁），154287 例为男性（64.5%），64335 例为 ST 段抬高型心肌梗死（STEMI；26.9%）。AMI 后 7 年生存率为 62.3%（STEMI 为 70.8%；非 ST 段抬高型心肌梗死[NSTEMI]为 59.2%）；65 岁以下人群的生存率超过 85%，但 85 岁及以上人群的生存率为 17.4%。120155 例患者（50.2%）接受了血运重建（STEMI，72.2%；NSTEMI，42.1%）；每个接受血运重建的患者组 7 年生存率均超过 80%，而未接受血运重建的患者组生存率低于 45%。年龄较大（85 岁及以上与 18-54 岁：校正后危险比[aHR]，10.6；95%CI，10.1-11.1）或女性（aHR，1.15；95%CI，1.13-1.17），与研究期间长期死亡率较高相关，而既往心力衰竭（aHR，1.79；95%CI，1.76-1.83）也是如此。这些患者中常见的几种非心脏疾病和老年综合征与长期生存率降低独立相关，包括重大和转移性癌症、肝硬化和终末期肝病以及痴呆。