Wong Hon Jen, Toh Keith Zhi Xian, Low Chen Ee, Yau Chun En, Teo Yao Hao, Teo Yao Neng, Ho Vanda W T, Tan Li Feng, Chai Ping, Loh Poay Huan, Yip James W L, Ho Andrew Fu-Wah, Foo David, Chia Pow-Li, Lim Patrick Zhan-Yun, Yeo Khung Keong, Chow Weien, Chong Daniel Thuan Tee, Hausenloy Derek J, Chan Mark Y Y, Sia Ching-Hui
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Medicine, National University Hospital, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
Can J Cardiol. 2025 Jul;41(7):1372-1382. doi: 10.1016/j.cjca.2025.01.031. Epub 2025 Jan 31.
Guideline-directed medical therapies (GDMTs), such as beta-blockers, antiplatelet drugs, lipid-lowering drugs, and renin-angiotensin system agents, have been associated with reduced risk of mortality after acute myocardial infarction (AMI). However, this survival benefit conferred by GDMTs in nonagenarians and centenarians (≥ 90 years old) is not well-defined.
We investigated restricted mean survival times of patients ≥ 90 years of age with first-onset AMI treated with GDMTs from 2007 to 2020 in the Singapore Myocardial Infarction Registry. Primary analyses involved stratification by number of GDMTs prescribed at discharge, with derivation of pairwise restricted mean survival ratios free from all-cause mortality at 1, 3, and 5 years. Secondary analyses evaluated individual GDMTs within combinations of 1-3 GDMTs.
The analysis included 3264 patients: 0 GDMTs (561 patients, 17.2%), 1-2 GDMTs (1294 patients, 39.6%), 3 GDMTs (904 patients, 27.7%), and 4 GDMTs (505 patients, 15.5%), with a median follow-up duration of 5.71 years. Patients who received 4 GDMTs at discharge were younger, had more comorbidities, were more likely to be smokers, and were more likely to have undergone percutaneous coronary intervention than those prescribed fewer GDMTs. A greater number of GDMT classes at discharge was associated with longer survival free from all-cause mortality at 1, 3, and 5 years. Each drug class within combinations of 1-3 GDMTs was associated with significant survival benefit at all time points, except for beta-blockers.
Prescription of any number of GDMTs to nonagenarians and centenarians after first-onset AMI is associated with significant survival benefit.
指南指导的药物治疗（GDMTs），如β受体阻滞剂、抗血小板药物、降脂药物和肾素 - 血管紧张素系统药物，与急性心肌梗死（AMI）后死亡率降低相关。然而，GDMTs对九旬老人和百岁老人（≥90岁）的生存益处尚不明确。
我们在新加坡心肌梗死登记处调查了2007年至2020年接受GDMTs治疗的首次发生AMI的90岁及以上患者的受限平均生存时间。主要分析按出院时开具的GDMTs数量分层，得出1、3和5年时无全因死亡率的两两受限平均生存比。次要分析评估了1 - 3种GDMTs组合中的每种GDMT。
分析纳入3264例患者：未使用GDMTs（561例患者，17.2%）、使用1 - 2种GDMTs（1294例患者，39.6%）、使用3种GDMTs（904例患者，27.7%）和使用4种GDMTs（505例患者，15.5%），中位随访时间为5.71年。出院时接受4种GDMTs的患者比开具较少GDMTs的患者更年轻，合并症更多，更可能是吸烟者，且更可能接受过经皮冠状动脉介入治疗。出院时更多种类的GDMT与1、3和5年时更长的无全因死亡率生存时间相关。除β受体阻滞剂外，1 - 3种GDMTs组合中的每种药物类别在所有时间点均与显著的生存益处相关。
首次发生AMI后，给九旬老人和百岁老人开具任何数量的GDMTs均与显著的生存益处相关。
