Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea.
Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
Medicine (Baltimore). 2024 Nov 29;103(48):e40697. doi: 10.1097/MD.0000000000040697.
Optimal medical therapy, including Beta-blockers (BB), inhibitors of the renin-angiotensin system (RAS), and statins, is recommended for patients with acute myocardial infarction (AMI) in the absence of contraindications. However, the optimal duration of these medications has not been clearly established in clinical studies. This observational study aimed to investigate the period during which these medications are associated with improved clinical outcomes. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), in-hospital survivors were selected. In a Cox-proportional hazard analysis of 12,200 patients, BB (hazard ratio [HR] = 0.73; 95% confidence interval [CI] = 0.57-0.95; P = .019), RAS inhibitors (HR 0.70; 95% CI = 0.55-0.89; P = .004), and statins at discharge (HR = 0.65; 95% CI = 0.48-0.87; P = .004) were all associated with lower 1-year cardiac mortality. At 1-year, 10,613 patients without all-cause death, myocardial infarction, revascularization, or re-hospitalization due to heart failure were selected for further analysis. RAS inhibitors (HR = 0.53; 95% CI = 0.37-0.76; P = .001) and statins (HR = 0.30; 95% CI = 0.14-0.61; P = .001) prescribed at 1-year were associated with lower 2-year cardiac mortality, whereas BB were not (HR = 0.79; 95% CI = 0.51-1.23; P = .23). However, none of these medications prescribed at 2-years were associated with reduced 3-year cardiac mortality among the 9232 patients who remained event-free until then. RAS inhibitors and statins were associated with reduced cardiac mortality for up to 2-years, and BB for up to 1-year after the initial attack. The effectiveness of these medications beyond these periods remains questionable.
在不存在禁忌的情况下，推荐急性心肌梗死（AMI）患者采用最佳的医学治疗，包括β受体阻滞剂（BB）、肾素-血管紧张素系统（RAS）抑制剂和他汀类药物。然而，这些药物的最佳持续时间在临床研究中尚未明确。本观察性研究旨在探讨这些药物与改善临床结局相关的时间段。在韩国急性心肌梗死登记-国立卫生研究院（KAMIR-NIH）登记的患者中，选择住院期间存活的患者。在对 12200 名患者进行 Cox 比例风险分析中，BB（风险比 [HR] = 0.73；95%置信区间 [CI] = 0.57-0.95；P = 0.019）、RAS 抑制剂（HR 0.70；95%CI = 0.55-0.89；P = 0.004）和出院时的他汀类药物（HR = 0.65；95%CI = 0.48-0.87；P = 0.004）均与较低的 1 年心脏死亡率相关。在 1 年时，选择了 10613 名没有全因死亡、心肌梗死、血运重建或因心力衰竭再次住院的患者进行进一步分析。RAS 抑制剂（HR = 0.53；95%CI = 0.37-0.76；P = 0.001）和他汀类药物（HR = 0.30；95%CI = 0.14-0.61；P = 0.001）在 1 年时的使用与较低的 2 年心脏死亡率相关，而 BB 则不然（HR = 0.79；95%CI = 0.51-1.23；P = 0.23）。然而，在 9232 名在此之前未发生任何事件的患者中，在 2 年时使用这些药物与降低 3 年心脏死亡率无关。RAS 抑制剂和他汀类药物在最初发作后 2 年内可降低心脏死亡率，BB 则可降低 1 年。这些药物在这些时间段之后的有效性仍存在疑问。
