Anastasiadis Filippos, Antoniadis Dimitrios, Chountis Dimitrios, Mantas Ioannis, Lekakis Ioannis, Elisaf Moses, Karvounis Charalampos, Manolis Athanasios, Hahalis Georgios, Kogias Ioannis, Tourtoglou Theodora, Gourlis Dimitrios, Tsounis Dimitrios
Cardiologist, Pireaus, Attica, Greece.
Cardiologist, Chrysoupoli, East Macedonia and Thrace, Greece.
Hellenic J Cardiol. 2023 Jul-Aug;72:24-33. doi: 10.1016/j.hjc.2023.01.007. Epub 2023 Feb 4.
In light of the scarcity of evidence, TIGREECE evaluated the clinical management and long-term outcomes of patients at high risk for an atherothrombotic event who have suffered a myocardial infarction (MI), managed by cardiologists/internists in routine hospital and private office settings in Greece.
TIGREECE, a multicenter, 3-year prospective cohort study, enrolled patients ≥50 years old, with a history of MI 1-3 years before enrollment and with at least one of the following risk factors: age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, and creatinine clearance 15-60 mL/min. The primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death.
Between 5 June 2014 and 25 July 2015, 305 eligible consented patients (median age: 67.3 years; 81.3% males; 14.8% active smokers; 80.7% overweight/obese) were enrolled; 52.5% had ≥2 qualifying risk factors. The median time from the index MI [ST-segment elevation myocardial infarction (STEMI) in 51.1%, non-STEMI in 33.1%] to enrollment was 1.7 years. Of the patients, 65.9% had been discharged on dual antiplatelet therapy. At enrollment, 94.4% were receiving antiplatelets: 60.0% single [acetylsalicylic acid (ASA): 43.3%; clopidogrel: 15.7%] and 34.4% dual (ASA + clopidogrel: 31.8%) therapy. The Kaplan-Meier estimated 3-year primary composite event rate was 9.3% [95% confidence interval (CI): 6.4-13.0), and the ischemic composite event rate was 6.7% (95% CI: 4.2-9.9).
Study results indicate that in the routine care of Greece one in ten patients experience a recurring cardiovascular event or death, mainly of ischemic origin, 1-3 years post-MI.
鉴于证据匮乏，希腊动脉粥样硬化血栓形成事件高危患者心肌梗死（MI）临床管理及长期预后评估（TIGREECE）研究，对希腊常规医院和私人诊所中心脏病专家/内科医生管理的心肌梗死患者进行了研究。
TIGREECE研究是一项多中心、为期3年的前瞻性队列研究，纳入年龄≥50岁、入组前1 - 3年有心肌梗死病史且至少具备以下危险因素之一的患者：年龄≥65岁、需药物治疗的糖尿病、既往第二次心肌梗死、多支冠状动脉疾病以及肌酐清除率为15 - 60 mL/分钟。主要结局为心肌梗死、需紧急血运重建的不稳定型心绞痛、中风或全因死亡的复合事件。
在2014年6月5日至2015年7月25日期间，305例符合条件并同意参与研究的患者（中位年龄：67.3岁；81.3%为男性；14.8%为当前吸烟者；80.7%超重/肥胖）入组；52.5%的患者具备≥2个符合条件的危险因素。从首次心肌梗死（51.1%为ST段抬高型心肌梗死（STEMI），33.1%为非STEMI）至入组的中位时间为1.7年。在这些患者中，65.9%在出院时接受双联抗血小板治疗。入组时，94.4%的患者正在接受抗血小板治疗：60.0%为单药治疗（阿司匹林（ASA）：43.3%；氯吡格雷：15.7%），34.4%为双联治疗（ASA + 氯吡格雷：31.8%）。采用Kaplan - Meier法估计的3年主要复合事件发生率为9.3%[95%置信区间（CI）：6.4 - 13.0]，缺血性复合事件发生率为6.7%（95%CI：4.2 - 9.9）。
研究结果表明，在希腊的常规医疗中，每10名心肌梗死患者中有1人在心肌梗死后1 - 3年发生复发性心血管事件或死亡，主要为缺血性原因。
