Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy.
Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Rev Esp Cardiol (Engl Ed). 2024 Mar;77(3):215-225. doi: 10.1016/j.rec.2023.07.001. Epub 2023 Jul 26.
After ST-segment myocardial infarction (STEMI), the impact of different adverse events on prognosis remains unknown. We aimed to assess very long-term predictors of patient-oriented composite endpoints (POCE) and investigate whether the occurrence of target vessel failure (TVF) vs a non-TVF event as the first event could potentially influence subsequent outcomes.
The EXAMINATION-EXTEND trial randomized STEMI patients to receive either an everolimus-eluting stent or a bare-metal stent. The follow-up period was 10 years. Predictors of POCE (a composite of all-cause death, any myocardial infarction, or any revascularization) were evaluated in the overall study population. The patients were stratified based on the type of first event (TVF-first vs non-TVF-first) and were compared in terms of subsequent POCE. TVF was defined as a composite of cardiac death, TV myocardial infarction, or TV revascularization.
Out of the 1498 enrolled patients, 529 (35.3%) experienced a POCE during the 10-year follow-up. Independent predictors of POCE were age, diabetes mellitus, previous myocardial infarction, peripheral arterial disease, and multivessel coronary disease. The first event was a TVF in 296 patients and was a non-TVF in 233 patients. No significant differences were observed between TVF-first and non-TVF-first patients in terms of subsequent POCE (21.7% vs 39.3%, time ratio 1.79; 95%CI, 0.87-3.67;P=.12) or its individual components.
At the 10-year follow-up, approximately one-third of STEMI patients had experienced at least 1 POCE. Independent predictors of these events were age, diabetes, and more extensive atherosclerotic disease. The occurrence of a TVF or a non-TVF as the first event did not seem to influence subsequent outcomes.
NCT04462315.
在 ST 段抬高型心肌梗死（STEMI）后，不同不良事件对预后的影响尚不清楚。我们旨在评估患者导向复合终点（POCE）的非常长期预测因素，并探讨首次事件中靶血管失败（TVF）与非-TVF 事件的发生是否可能影响随后的结局。
EXAMINATION-EXTEND 试验将 STEMI 患者随机分为接受依维莫司洗脱支架或裸金属支架治疗。随访时间为 10 年。在整个研究人群中评估 POCE（全因死亡、任何心肌梗死或任何血运重建的复合终点）的预测因素。根据首次事件的类型（TVF 首发与非-TVF 首发）对患者进行分层，并比较随后 POCE 的差异。TVF 定义为心脏死亡、TV 心肌梗死或 TV 血运重建的复合终点。
在纳入的 1498 例患者中，529 例（35.3%）在 10 年随访期间发生 POCE。POCE 的独立预测因素为年龄、糖尿病、既往心肌梗死、外周动脉疾病和多支血管性冠状动脉疾病。296 例患者的首发事件为 TVF，233 例患者的首发事件为非-TVF。在随后的 POCE 方面，TVF 首发和非-TVF 首发患者之间无显著差异（21.7%与 39.3%，时间比 1.79；95%CI，0.87-3.67；P=.12）或其各组成部分。
在 10 年随访时，约三分之一的 STEMI 患者至少发生了 1 次 POCE。这些事件的独立预测因素为年龄、糖尿病和更广泛的动脉粥样硬化性疾病。首次发生 TVF 或非-TVF 似乎并不影响随后的结局。
NCT04462315。
