Ohashi Jumpei, Sakakura Kenichi, Jinnouchi Hiroyuki, Taniguchi Yousuke, Tsukui Takunori, Watanabe Yusuke, Yamamoto Kei, Seguchi Masaru, Wada Hiroshi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Circ J. 2022 Sep 22;86(10):1519-1526. doi: 10.1253/circj.CJ-22-0188. Epub 2022 May 31.
As severity of acute myocardial infarction (AMI) varies widely, several risk stratifications for AMI have been reported. We have introduced a novel AMI risk stratification system linked to a rehabilitation program (novel AMI risk stratification; nARS), which stratified AMI patients into low (L)-, intermediate (I)-, and high (H)-risk groups. The purpose of this retrospective study was to compare the long-term clinical outcomes in patients with AMI among L-, I-, H-risk groups.
This study included 773 AMI patients, and assigned them into the L-risk group (n=332), the I-risk group (n=164), and the H-risk group (n=277). The primary endpoint was major cardiovascular events (MACE), defined as the composite of all-cause death, readmission for heart failure, non-fatal myocardial infarction, and target vessel revascularization after the discharge of index admission. The median follow-up duration was 686 days. MACE was most frequently observed in the H-risk group (39.4%), followed by the I-risk group (23.2%), and least in the L-risk group (19.9%) (P<0.001). The multivariate Cox hazard analysis revealed that the H-risk was significantly associated with MACE (HR 2.166, 95% CI 1.543-3.041, P<0.001) after controlling for multiple confounding factors.
H-risk according to nARS was significantly associated with long-term adverse events after hospital discharge for patients with AMI. These results support the validity of nARS as a risk marker for long-term outcomes.
由于急性心肌梗死（AMI）的严重程度差异很大，已有多种针对AMI的风险分层报道。我们引入了一种与康复计划相关的新型AMI风险分层系统（新型AMI风险分层；nARS），该系统将AMI患者分为低（L）、中（I）、高（H）风险组。这项回顾性研究的目的是比较L、I、H风险组中AMI患者的长期临床结局。
本研究纳入773例AMI患者，将他们分为L风险组（n = 332）、I风险组（n = 164）和H风险组（n = 277）。主要终点是主要心血管事件（MACE），定义为全因死亡、因心力衰竭再次入院、非致命性心肌梗死以及首次入院出院后靶血管血运重建的综合情况。中位随访时间为686天。MACE在H风险组中最常见（39.4%），其次是I风险组（23.2%），在L风险组中最少见（19.9%）（P<0.001）。多因素Cox风险分析显示，在控制多个混杂因素后，H风险与MACE显著相关（HR 2.166，95%CI 1.543 - 3.041，P<0.001）。
根据nARS，H风险与AMI患者出院后的长期不良事件显著相关。这些结果支持nARS作为长期结局风险标志物的有效性。
