Department of Cardiology, Rabin Medical Center, Petach Tikva.
Department of Cardiology, Meir Medical Center, Affiliated to the faculty of medicine, Tel-Aviv university, Tel-Aviv, Kfar-Saba, Israel.
Coron Artery Dis. 2022 Jan 1;31(1):1-8. doi: 10.1097/MCA.0000000000001058.
Despite recent progress in coronary artery disease treatment, ST-segment elevation myocardial infarction (STEMI) remains a very high-risk medical condition. Whether recent patients' outcomes, following implementation of the 2012 European Society of Cardiology (ESC) STEMI guidelines have improved, is yet unclear.
The study was based on a prospective detailed registry of 2004 consecutive patients with STEMI treated with primary percutaneous coronary intervention (pPCI). We compared trends during two different time periods (2006-2012 vs. 2012-2018). Endpoints included mortality and major adverse cardiac events (MACE: death, repeat myocardial infarction, target vessel revascularization and coronary artery bypass surgery) at 1 month, 1 and 2 years. Rates of transradial interventions have risen significantly (67.3 vs. 42.0%; P < 0.01), as have rates of prasugrel administration (69.8 vs. 4.5%; P < 0.01) and use of drug eluting stents (75.5 vs. 56.5%; P < 0.01). Both at 1 and at 2 years, MACE was significantly lower in the later period (11.6 vs. 20.9%; P < 0.01 and 18.9 vs. 25.4%; P < 0.01 respectively), whereas mortality was only significantly lower after 1 year (5.8 vs. 8.6%; P = 0.02). Cox regression identified the later period (2012-2018) to independently and favorably impact MACE (hazard ratio, -0.69; 95% CI, 0.56-0.85; P < 0.01) but not mortality (hazard ratio, -0.76; 95% CI, 0.54-1.05; P = 0.09).
Among patients treated with pPCI for STEMI, adoption of the contemporary evidence-based treatments is associated with better MACE derived outcomes, following the inception of the 2012 ESC guidelines. Nonetheless, the long-term mortality was marginally (but not significantly) lower, which indicates an unmet need for further improvement.
尽管在治疗冠状动脉疾病方面取得了最新进展，但 ST 段抬高型心肌梗死（STEMI）仍然是一种高危疾病。目前尚不清楚 2012 年欧洲心脏病学会（ESC）STEMI 指南实施后，最近患者的预后是否有所改善。
本研究基于一项前瞻性详细登记的 2004 例接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 连续患者。我们比较了两个不同时间段（2006-2012 年与 2012-2018 年）的趋势。终点包括 1 个月、1 年和 2 年时的死亡率和主要不良心脏事件（MACE：死亡、再次心肌梗死、靶血管血运重建和冠状动脉旁路移植术）。经桡动脉介入治疗的比例显著上升（67.3%比 42.0%；P<0.01），普拉格雷的使用率（69.8%比 4.5%；P<0.01）和药物洗脱支架的使用率（75.5%比 56.5%；P<0.01）也有所上升。在 1 年和 2 年时，后期 MACE 显著降低（11.6%比 20.9%；P<0.01 和 18.9%比 25.4%；P<0.01），而仅在 1 年后死亡率显著降低（5.8%比 8.6%；P=0.02）。Cox 回归分析表明，后期（2012-2018 年）独立且有利地影响 MACE（风险比，-0.69；95%置信区间，0.56-0.85；P<0.01），但不影响死亡率（风险比，-0.76；95%置信区间，0.54-1.05；P=0.09）。
在接受 pPCI 治疗的 STEMI 患者中，采用当代基于证据的治疗方法与 2012 年 ESC 指南实施后更好的 MACE 相关结局相关。尽管如此，长期死亡率略有（但不显著）降低，这表明仍需要进一步改进。
