急性心肌梗死后射血分数轻度降低患者的两年临床结局：来自前瞻性KAMIR-NIH注册研究的见解
Two-year clinical outcome of patients with mildly reduced ejection fraction after acute myocardial infarction: insights from the prospective KAMIR-NIH Registry.
作者信息
Jeon Ho Sung, Lee Jun-Won, Moon Jin Sil, Kang Dae Ryong, Lee Jung-Hee, Youn Young Jin, Ahn Min-Soo, Ahn Sung Gyun, Yoo Byung-Su
机构信息
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea.
Center of Biomedical Data Science, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea.
出版信息
Front Cardiovasc Med. 2024 Sep 20;11:1458740. doi: 10.3389/fcvm.2024.1458740. eCollection 2024.
BACKGROUND
Left ventricular ejection fraction (LVEF) is a crucial prognostic indicator of acute myocardial infarction (AMI). However, there is a lack of studies on the clinical characteristics and prognosis of patients with mildly reduced ejection fraction (EF) after AMI.
METHODS
We categorized 6,553 patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) between November 2011 and December 2015 into three groups based on their EF, as assessed by echocardiography during index hospitalization: reduced EF (LVEF ≤40%), mildly reduced EF (LVEF 41%-49%), and preserved EF (LVEF ≥50%). The primary outcome was all-cause death within 2 years. The secondary outcomes included myocardial infarction (MI), revascularization, and patient-oriented composite endpoint (POCE), which was defined as a composite of all-cause death, any MI, or revascularization.
RESULTS
Of the total 6,553 patients, 884 (13.5%) were classified into the reduced EF group, 1,749 (26.7%) into the mildly reduced EF group, and 3,920 (59.8%) into the preserved EF group. Patients with mildly reduced EF exhibited intermediate mortality (reduced EF, 24.7%; mildly reduced EF, 8.3%; preserved EF, 4.6%; < 0.0001), MI (3.9% vs. 2.7% vs. 2.6%; < 0.0046), and POCE (33.0% vs. 15.6% vs. 12.4%; < 0.0001) rates, albeit closer to those of the preserved EF. After adjustment for demographics, risk factors, admission status, and discharge medications, patients with mildly reduced EF showed a lower risk of all-cause death than those with reduced EF (mildly reduced EF group as a reference: HR, 1.74; 95% CI, 1.40-2.18; < 0.001), but it did not differ significantly from those with preserved EF (HR, 0.94; 95% CI, 0.75-1.18; = 0.999).
CONCLUSIONS
Over a 2-year follow-up period, patients with AMI and mildly reduced EF demonstrated better prognoses than those with reduced EF, but did not differ significantly from those with preserved EF.
CLINICAL TRIAL REGISTRATION
cris.nih.go.kr, identifier: KCT-0000863.
背景
左心室射血分数（LVEF）是急性心肌梗死（AMI）的关键预后指标。然而，关于AMI后射血分数（EF）轻度降低患者的临床特征和预后的研究较少。
方法
我们将2011年11月至2015年12月期间来自韩国急性心肌梗死注册研究-国立卫生研究院（KAMIR-NIH）的6553例AMI患者，根据其在首次住院期间经超声心动图评估的EF分为三组：EF降低组（LVEF≤40%）、EF轻度降低组（LVEF 41%-49%）和EF保留组（LVEF≥50%）。主要结局是2年内的全因死亡。次要结局包括心肌梗死（MI）、血运重建和以患者为导向的复合终点（POCE），POCE定义为全因死亡、任何MI或血运重建的复合指标。
结果
在总共6553例患者中，884例（13.5%）被分类为EF降低组，1749例（26.7%）为EF轻度降低组，3920例（59.8%）为EF保留组。EF轻度降低的患者表现出中等的死亡率（EF降低组为24.7%；EF轻度降低组为8.3%；EF保留组为4.6%；P<0.0001）、MI发生率（3.9%对2.7%对2.6%；P<0.0046）和POCE发生率（33.0%对15.6%对12.4%；P<0.0001），尽管更接近EF保留组。在对人口统计学、危险因素、入院状态和出院用药进行调整后，EF轻度降低的患者全因死亡风险低于EF降低的患者（以EF轻度降低组为参照：HR，1.74；95%CI，1.40-2.18；P<0.001），但与EF保留的患者无显著差异（HR，0.94；95%CI，0.75-1.18；P=0.999）。
结论
在2年的随访期内，AMI且EF轻度降低的患者预后优于EF降低的患者，但与EF保留的患者无显著差异。
临床试验注册
cris.nih.go.kr，标识符：KCT-0000863。
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