早发冠心病患者首次心肌梗死：探讨当代支架治疗后患者特征和结局。
First myocardial infarction in patients with premature coronary artery disease: insights into patient characteristics and outcome after treatment with contemporary stents.
机构信息
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningsplein 1, Enschede 7512 KZ, The Netherlands.
Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands.
出版信息
Eur Heart J Acute Cardiovasc Care. 2023 Nov 16;12(11):774-781. doi: 10.1093/ehjacc/zuad098.
AIMS
Patients with premature coronary artery disease (CAD) have a higher incidence of myocardial infarction (MI) than patients with non-premature CAD. The aim of the present study is to asess differences in clinical outcome after a first acute MI, percutaneously treated with new-generation drug-eluting stents between patients with premature and non-premature CAD.
METHODS AND RESULTS
We pooled and analysed the characteristics and clinical outcome of all patients with a first MI (and no previous coronary revascularization) at time of enrolment, in four large-scale drug-eluting stent trials. Coronary artery disease was classified premature in men aged <50 and women <55 years. Myocardial infarction patients with premature and non-premature CAD were compared. The main endpoint was major adverse cardiac events (MACE): all-cause mortality, any MI, emergent coronary artery bypass surgery, or clinically indicated target lesion revascularization. Of 3323 patients with a first MI, 582 (17.5%) had premature CAD. These patients had lower risk profiles and underwent less complex interventional procedures than patients with non-premature CAD. At 30-day follow-up, the rates of MACE [hazard ratio (HR): 0.22, 95% confidence interval (CI): 0.07-0.71; P = 0.005), MI (HR: 0.22, 95% CI: 0.05-0.89; P = 0.020), and target vessel failure (HR: 0.30, 95% CI: 0.11-0.82; P = 0.012) were lower in patients with premature CAD. At 1 year, premature CAD was independently associated with lower rates of MACE (adjusted HR: 0.50, 95% CI: 0.26-0.96; P = 0.037) and all-cause mortality (adjusted HR: 0.24, 95% CI: 0.06-0.98; P = 0.046). At 2 years, premature CAD was independently associated with lower mortality (adjusted HR: 0.16, 95% CI: 0.05-0.50; P = 0.002).
CONCLUSIONS
First MI patients with premature CAD, treated with contemporary stents, showed lower rates of MACE and all-cause mortality than patients with non-premature CAD, which is most likely related to differences in cardiovascular risk profile. TWENTE trials: TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).
目的
患有早发冠心病（CAD）的患者比非早发 CAD 患者发生心肌梗死（MI）的几率更高。本研究的目的是评估在首次急性 MI 后，使用新一代药物洗脱支架进行经皮治疗的早发和非早发 CAD 患者的临床结果差异。
方法和结果
我们汇总并分析了四项大型药物洗脱支架试验中所有首次 MI（且无先前冠状动脉血运重建）患者的特征和临床结果。男性 <50 岁和女性 <55 岁的 CAD 被归类为早发。将早发和非早发 CAD 的 MI 患者进行比较。主要终点是主要不良心脏事件（MACE）：全因死亡率、任何 MI、紧急冠状动脉旁路手术或临床指征的靶病变血运重建。在 3323 例首次 MI 患者中，582 例（17.5%）为早发 CAD。这些患者的风险状况较低，接受的介入治疗程序也比非早发 CAD 患者更简单。在 30 天随访时，MACE 的发生率[风险比（HR）：0.22，95%置信区间（CI）：0.07-0.71；P = 0.005]、MI（HR：0.22，95% CI：0.05-0.89；P = 0.020）和靶血管失败（HR：0.30，95% CI：0.11-0.82；P = 0.012）较低。在 1 年时，早发 CAD 与较低的 MACE 发生率独立相关（调整后的 HR：0.50，95% CI：0.26-0.96；P = 0.037）和全因死亡率（调整后的 HR：0.24，95% CI：0.06-0.98；P = 0.046）相关。在 2 年时，早发 CAD 与死亡率降低独立相关（调整后的 HR：0.16，95% CI：0.05-0.50；P = 0.002）。
结论
使用现代支架治疗的早发 CAD 首次 MI 患者的 MACE 和全因死亡率低于非早发 CAD 患者，这很可能与心血管风险状况的差异有关。TWENTE 试验：TWENTE I，clinicaltrials.gov：NCT01066650）、DUTCH PEERS（TWENTE II，NCT01331707）、BIO-RESORT（TWENTE III，NCT01674803）和 BIONYX（TWENTE IV，NCT02508714）。
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