Ravn Pauline Bohsen, Falkentoft Alexander Christian, Garred Caroline A H, Bruhn Jonas, Christensen Daniel Mølager, Sehested Thomas S G, Gislason Gunnar H, Køber Lars, Olsen Niels Thue, Torp-Petersen Christian, Fosbøl Emil, Bruun Niels Eske, Schou Morten, Ruwald Anne-Christine
Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
Eur Heart J Qual Care Clin Outcomes. 2023 Apr 26;9(3):268-280. doi: 10.1093/ehjqcco/qcac033.
We investigated temporal trends in major cardiovascular events following first-time myocardial infarction (MI) and trends in revascularization and pharmacotherapy from 2000 to 2017.
Using nationwide registries, we identified 120 833 Danish patients with a first-time MI between 2000 and 2017. We investigated 30-day and 1-year mortality and the 1-year risk of first-time admission for heart failure (HF) and recurrent MI. Patients were younger with a higher prevalence of hypertension and diabetes in 2015-2017 compared with 2000-2002. The patients were predominantly male (65.6%), and the median age declined by 3 years through the periods. Percutaneous coronary interventions within 7 days after first-time MI increased significantly (2000: 11.4% vs. 2017: 68.6%; Ptrend < 0.001). Cardiovascular medication after first-time MI changed significantly in the same period. Absolute risks and adjusted rates of outcomes were significantly lower in 2015-2017 compared with 2000-2002: 30-day mortality: 6.5% vs. 14.1% [hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.48-0.55); 1-year mortality 10.7% vs. 21.8% (HR 0.52, 95% CI: 0.50-0.55); recurrent MI: 4.0% vs. 7.8% (HR 0.56, 95% CI: 0.51-0.62); and first-time admission for HF: 2.9% vs. 3.7% (HR 0.82, 95% CI: 0.73-0.92). The rates of 30-day/1-year mortality and recurrent MI showed significantly decreasing trends (Ptrend < 0.001). The rates of first-time admission for HF were borderline significant (Ptrend = 0.045).
From 2000 to 2017, we observed a decreasing risk of recurrent MI, first-time admission for HF, and all-cause mortality in patients with a first-time MI. In the same period, we observed a high rate of guideline-recommended pharmacological treatment after first-time MI as well as increasing rate of early revascularization in Denmark.
The results from the current study portrait the risk of all-cause mortality, recurrent MI, and first-time admission for HF in a real-life setting with a very high utilization of early revascularization and guideline-recommended pharmacological therapy. We observed a temporal trend of improved survival, reduced risk of recurrent MI, as well as reduced risk of first-time admission for HF after first-time MI from 2000 through 2017. We observed an increase in the overall use of revascularization, as well as early revascularization and use of guideline-recommended pharmacotherapy. Our study reveals important results from real-life, nationwide data, showing a reduced risk of cardiovascular outcomes after first-time MI during the past 20 years. Current guidelines are based on results from clinical trials. Our real-life results add additionally important knowledge on patients' prognosis after first-time MI and underline the importance of treating MI according to guideline recommendations.
我们研究了首次心肌梗死（MI）后主要心血管事件的时间趋势以及2000年至2017年血运重建和药物治疗的趋势。
利用全国登记处的数据，我们确定了2000年至2017年间120833例丹麦首次发生MI的患者。我们调查了30天和1年死亡率以及首次因心力衰竭（HF）和复发性MI入院的1年风险。与2000 - 2002年相比，2015 - 2017年的患者更年轻，高血压和糖尿病患病率更高。患者以男性为主（65.6%），且在此期间中位年龄下降了3岁。首次MI后7天内的经皮冠状动脉介入治疗显著增加（2000年：11.4% vs. 2017年：68.6%；P趋势<0.001）。同期，首次MI后的心血管药物治疗发生了显著变化。与2000 - 2002年相比，2015 - 2017年结局的绝对风险和调整率显著降低：30天死亡率：6.5% vs. 14.1% [风险比（HR）0.52，95%置信区间（CI）：0.48 - 0.55]；1年死亡率10.7% vs. 21.8%（HR 0.52，95% CI：0.50 - 0.55）；复发性MI：4.0% vs. 7.8%（HR 0.56，95% CI：0.51 - 0.62）；首次因HF入院：2.9% vs. 3.7%（HR 0.82，95% CI：0.73 - 0.92）。30天/1年死亡率和复发性MI的发生率呈显著下降趋势（P趋势<0.001）。首次因HF入院的发生率临界显著（P趋势 = 0.045）。
从2000年到2017年，我们观察到首次发生MI的患者复发性MI、首次因HF入院和全因死亡风险降低。同期，我们观察到丹麦首次MI后指南推荐的药物治疗率较高，以及早期血运重建率增加。
本研究结果描绘了在早期血运重建和指南推荐的药物治疗利用率非常高的现实环境中全因死亡、复发性MI和首次因HF入院的风险。我们观察到2000年至2017年首次MI后生存改善、复发性MI风险降低以及首次因HF入院风险降低的时间趋势。我们观察到血运重建的总体使用增加，以及早期血运重建和指南推荐的药物治疗的使用增加。我们的研究揭示了来自现实生活、全国性数据的重要结果，显示过去20年首次MI后心血管结局风险降低。当前指南基于临床试验结果。我们的现实生活结果额外增加了关于首次MI后患者预后的重要知识，并强调了根据指南建议治疗MI的重要性。
