Batty Jonathan A, Del Toro Tamara, Drayton Daniel J, Booth Eleanor, Anik Evrim, Sturley Charlotte, Brown Benjamin C, Kearney Mark T, Hall Marlous
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
JACC Adv. 2025 Jul 22;4(8):102006. doi: 10.1016/j.jacadv.2025.102006.
Multimorbidity (the presence of multiple long-term conditions) increases the complexity of management decisions for patients presenting with acute coronary syndrome (ACS).
The purpose of this study was to ascertain the prevalence of multimorbidity in ACS and assess its impact on clinical management and outcomes.
Medline, Web of Science, Embase, and Cochrane were searched to July 2024 for studies that reported: 1) the prevalence of multimorbidity in patients with incident ACS or 2) ACS management and/or clinical outcomes, stratified by multimorbidity status. Random-effects meta-analysis was performed to calculate pooled summary statistics and was supported by narrative synthesis.
Overall, 41 studies were included. Those at low risk of bias (23 studies; n = 9,227,657) demonstrated a pooled prevalence of multimorbidity of 46.6% (95% CI: 38.9%-54.2%). Study-level determinants of prevalence included study setting (high-income: 48.5% [40.5%-56.5%] vs low- to middle-income countries: 35.3 [30.5%-40.3%]); P = 0.006) and the number of conditions in the per-study definition of multimorbidity (R = 79.6%; P < 0.001). Individual-level determinants of multimorbidity included advanced age, non-ST-segment elevation presentation, previous cardiac procedures, and greater body mass index. Multimorbidity was associated with reduced usage of invasive management and secondary preventative medication. Multimorbidity was associated with short-term mortality (≤30 day; relative risk [RR] 95% CI: 1.43 [95% CI: 1.14-1.78]; P < 0.01) and longer-term mortality (>30 day; RR: 1.87 [95% CI: 1.51-2.32]; P < 0.01). Each additional pre-existing long-term condition was associated with a 16% excess risk of mortality (RR: 1.16 [95% CI: 1.06-1.26]; P < 0.01).
Multimorbidity is common, associated with reduced use of guideline-directed therapies and adverse clinical outcomes in patients with ACS. (The prevalence of multimorbidity and its impact on clinical outcomes in patients with acute myocardial infarction: a systematic review and meta-analysis; CRD42023447122).
多种疾病并存（即存在多种长期病症）增加了急性冠状动脉综合征（ACS）患者管理决策的复杂性。
本研究的目的是确定ACS中多种疾病并存的患病率，并评估其对临床管理和结局的影响。
检索截至2024年7月的Medline、科学网、Embase和Cochrane数据库，查找报告以下内容的研究：1）新发ACS患者中多种疾病并存的患病率，或2）按多种疾病并存状态分层的ACS管理和/或临床结局。采用随机效应荟萃分析计算合并汇总统计量，并辅以叙述性综合分析。
总体而言，纳入了41项研究。那些偏倚风险较低的研究（23项研究；n = 9,227,657）显示多种疾病并存的合并患病率为46.6%（95%置信区间：38.9%-54.2%）。患病率的研究水平决定因素包括研究背景（高收入国家：48.5%[40.5%-56.5%] vs 低收入至中等收入国家：35.3%[30.5%-40.3%]；P = 0.006）以及每项研究中多种疾病并存定义中的病症数量（R = 79.6%；P < 0.001）。多种疾病并存的个体水平决定因素包括高龄、非ST段抬高表现、既往心脏手术以及更高的体重指数。多种疾病并存与侵入性治疗和二级预防药物使用减少有关。多种疾病并存与短期死亡率（≤30天；相对风险[RR] 95%置信区间：1.43[95%置信区间：1.14-1.78]；P < 0.01）和长期死亡率（>30天；RR：1.87[95%置信区间：1.51-2.32]；P < 0.01）相关。每增加一种预先存在的长期病症，死亡风险就会增加16%（RR：1.16[95%置信区间：1.06-1.26]；P < 0.01）。
多种疾病并存很常见，与ACS患者中指南指导治疗的使用减少及不良临床结局相关。（急性心肌梗死患者中多种疾病并存的患病率及其对临床结局的影响：系统评价和荟萃分析；CRD42023447122）
