Choi Jin-Ho, Hyun Dahee, Hur Seung Ho, Rha Seung Woon, Joo Seung Jae, Kim Hyo-Soo, Jeong Myung Ho
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2025 Sep;40(5):780-789. doi: 10.3904/kjim.2025.068. Epub 2025 Aug 29.
BACKGROUND/AIMS: While the clinical effectiveness of guideline-directed medical therapy (GDMT) is well established in patients with acute myocardial infarction (AMI), its specific impact on cause-specific mortality remains unclear. This study aimed to investigate the impact of GDMT on both cardiac and non-cardiac mortality in AMI patients.
Data of the KAMIR-NIH, a multicenter prospective registry of AMI in Korea between 2011 and 2015, were included. The competing risks of cardiac and non-cardiac death in patients who received GDMT were compared with those who did not, using a multivariable-adjusted cumulative incidence analysis of propensity score-matched patients. Primary endpoint of interest was 3-year cardiac and non-cardiac mortality.
Of the 12,815 patients enrolled, 2,700 matched pairs with a mean age of 64.9 ± 12.2 years were analyzed. The cumulative incidence of cardiac death (5.0% vs. 8.6%; subdistribution hazard ratio [sHR] 0.53; 95% CI 0.43-0.67) and non-cardiac death (3.2% vs. 4.5%; sHR 0.69; 95% CI 0.52-0.92) was significantly lower in patients receiving GDMT compared to those who did not (all p < 0.05). These results were also consistent in 30-day landmark analyses.
In patients with AMI, the use of GDMT was linked to a reduced risk of both cardiac and non-cardiac death over a period of 3 years. These findings support the continued adoption of GDMT in clinical practice.
背景/目的：虽然在急性心肌梗死（AMI）患者中，指南指导的药物治疗（GDMT）的临床有效性已得到充分证实，但其对特定病因死亡率的具体影响仍不清楚。本研究旨在调查GDMT对AMI患者心脏和非心脏死亡率的影响。
纳入KAMIR-NIH的数据，这是一项2011年至2015年韩国AMI多中心前瞻性登记研究。使用倾向评分匹配患者的多变量调整累积发病率分析，比较接受GDMT的患者与未接受GDMT的患者心脏和非心脏死亡的竞争风险。主要关注终点是3年心脏和非心脏死亡率。
在纳入的12815例患者中，分析了2700对匹配对，平均年龄为64.9±12.2岁。与未接受GDMT的患者相比，接受GDMT的患者心脏死亡累积发病率（5.0%对8.6%；亚分布风险比[sHR]0.53；95%CI 0.43-0.67）和非心脏死亡累积发病率（3.2%对4.5%；sHR 0.69；95%CI 0.52-0.92）显著更低（所有p<0.05）。这些结果在30天标志性分析中也一致。
在AMI患者中，使用GDMT与3年内心脏和非心脏死亡风险降低相关。这些发现支持在临床实践中继续采用GDMT。
