Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
International Healthcare Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
Clin Cardiol. 2023 Oct;46(10):1253-1259. doi: 10.1002/clc.24091. Epub 2023 Jul 24.
In South Korea, the number of people with dementia is rising at a worrisome rate, and many of them also have acute myocardial infarction (AMI), a disease with a high mortality rate.
We speculated that dementia and drug compliance have significant impact on the mortality of patients with AMI.
The study derived data from the National Health Insurance Service-Senior for a retrospective cohort study. The total number of patients diagnosed with AMI for the first time between 2007 and 2013 was 16 835, among whom 2021 had dementia. Medication possession ratio (MPR) was used to assess medication adherence.
AMI patients with dementia had unfavorable baseline characteristics; they had significantly higher risk of all-cause mortality (hazard ratio [HR]: 2.49; 95% confidence interval [CI]: 2.34-2.66; p < .001) and lower MPR (aspirin: 21.9% vs. 42.8%; p < .001). AMI patients were stratified by presence of dementia and medication adherence, and the survival rate was the highest among those with no dementia and good adherence, followed by those with no dementia and poor adherence, those with dementia and good adherence, and those with dementia and poor adherence. The multivariable analysis revealed that dementia (HR: 1.64; 95% CI: 1.53-1.75; p < .001) and poor adherence to medication (HR: 1.60; 95% CI: 1.49-1.71; p < .001) had a significant association with all-cause mortality in AMI patients.
AMI patients with dementia have a higher mortality rate. Their prognosis is negatively affected by their poorer medication adherence than patients without dementia.
在韩国，痴呆症患者的数量以令人担忧的速度增长，其中许多人还患有急性心肌梗死（AMI），这是一种死亡率很高的疾病。
我们推测痴呆症和药物依从性对 AMI 患者的死亡率有显著影响。
这项研究从 2007 年至 2013 年期间首次被诊断为 AMI 的 16835 名患者中提取数据，其中 2021 名患有痴呆症。药物使用比例（MPR）用于评估药物依从性。
患有痴呆症的 AMI 患者具有不利的基线特征；他们的全因死亡率风险显著增加（风险比[HR]：2.49；95%置信区间[CI]：2.34-2.66；p<0.001），药物使用比例较低（阿司匹林：21.9%比 42.8%；p<0.001）。根据痴呆症和药物依从性对 AMI 患者进行分层，无痴呆症且药物依从性良好的患者生存率最高，其次是无痴呆症且药物依从性较差的患者、有痴呆症且药物依从性良好的患者，以及有痴呆症且药物依从性较差的患者。多变量分析显示，痴呆症（HR：1.64；95% CI：1.53-1.75；p<0.001）和药物依从性差（HR：1.60；95% CI：1.49-1.71；p<0.001）与 AMI 患者的全因死亡率显著相关。
患有痴呆症的 AMI 患者死亡率较高。与无痴呆症的患者相比，他们较差的药物依从性对预后产生负面影响。
