Hoffmann Fabian, Fassbender Patricia, Zander Wilhelm, Ulbrich Lisa, Kuhr Kathrin, Adler Christoph, Halbach Marcel, Reuter Hannes
Department of Internal Medicine III, University of Cologne, Cologne, Germany.
Department of Cardiovascular Aerospace Medicine, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.
Front Cardiovasc Med. 2022 Feb 24;9:785657. doi: 10.3389/fcvm.2022.785657. eCollection 2022.
Mortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event.
Determining the impact of prescription of guideline-recommended therapy after STEMI in two cohorts, patients with and without history of arterial hypertension, on survival.
1,025 patients of the Cologne Infarction Model registry with invasively adjudicated STEMI were dichotomized according to their history of arterial hypertension. We recorded prescription rates and dosing of RAS-inhibitors, β-blockers and statins in all patients. The primary outcome was all-cause death. Mean follow-up was 2.5 years.
Mean age was 64 ± 13 years, 246 (25%) were women. 749 (76%) patients had a history of hypertension. All-cause mortality was 24.2%, 30-day and 1-year mortality was 11.3% and 16.6%, respectively. History of hypertension correlated with lower mortality (hazard ratio [HR], @30 days: 0.41 [0.27-0.62], @1 year: 0.37 [0.26-0.53]). After adjusting for age, sex, Killip-class, diabetes mellitus, body-mass index, kidney function and statin prescription at discharge 1-year mortality HR was 0.24 (0.12-0.48). At discharge, prescription rates for RAS-inhibitors, β-blockers and statins, as well as individual dosing and long-term persistence of RAS-inhibitors were higher in patients with history of hypertension. On the same lines, prescription rates for RAS-inhibitors, β-blockers and statins at discharge correlated significantly with lower mortality regardless of history of hypertension.
Patients with history of hypertension show higher penetration of guideline recommended drug therapy after STEMI, which may contribute to better survival. Better tolerance of β-blockers and RAS-inhibitors in patients with history of hypertension, not hypertension itself, likely explains these differences in prescription and dosing.
ST段抬高型心肌梗死（STEMI）后的死亡率取决于初始事件后的最佳药物治疗。
确定在两个队列中，即有和没有动脉高血压病史的患者中，STEMI后指南推荐治疗的处方对生存率的影响。
将科隆梗死模型登记处的1025例经侵入性判定为STEMI的患者根据其动脉高血压病史进行二分法分类。我们记录了所有患者中RAS抑制剂、β受体阻滞剂和他汀类药物的处方率和剂量。主要结局是全因死亡。平均随访时间为2.5年。
平均年龄为64±13岁，246例（25%）为女性。749例（76%）患者有高血压病史。全因死亡率为24.2%，30天和1年死亡率分别为11.3%和16.6%。高血压病史与较低的死亡率相关（风险比[HR]，30天时：0.41[0.27 - 0.62]，1年时：0.37[0.26 - 0.53]）。在调整年龄、性别、Killip分级、糖尿病、体重指数、肾功能和出院时他汀类药物处方后，1年死亡率HR为0.24（0.12 - 0.48）。出院时，有高血压病史的患者中RAS抑制剂、β受体阻滞剂和他汀类药物的处方率，以及RAS抑制剂的个体剂量和长期持续性更高。同样，无论有无高血压病史，出院时RAS抑制剂、β受体阻滞剂和他汀类药物的处方率与较低的死亡率显著相关。
有高血压病史的患者在STEMI后对指南推荐药物治疗的依从性更高，这可能有助于提高生存率。高血压病史患者对β受体阻滞剂和RAS抑制剂的耐受性更好，而非高血压本身，可能解释了这些处方和剂量上的差异。
