Hämäläinen H, Luurila O J, Kallio V, Knuts L R
Social Insurance Institution, Research and Development Centre, Turku, Finland.
Eur Heart J. 1995 Dec;16(12):1839-44. doi: 10.1093/oxfordjournals.eurheartj.a060837.
The study was set up to evaluate the long-term effects on mortality of a comprehensive rehabilitation and secondary prevention programme lasting 3 years after acute myocardial infarction. The study group consisted of 375 consecutive, non-selected patients under 65 years of age randomly allocated to an intervention group (188 patients) or a control group (187 patients). After 15 years follow-up significantly lower incidence of sudden death (16.5% vs 28.9%, P = 0.006) and coronary mortality (47.9% vs 58.5%, P = 0.04) were seen in the intervention group compared with controls. Total mortality was 64.4% and 66.8%, respectively (ns). The incidence of cancer death was 16 in the intervention group and three in the controls. Cardiac failure, enlarged heart, New York Heart Association functional class II or more and membership in the control group were significantly associated with coronary mortality during the first 3 years, and after 3 years enlarged heart, diabetes and reinfarction were associated with late coronary death. Thus, comprehensive multifactorial intervention after acute myocardial infarction had favourable long-term effects on coronary mortality and sudden death but no effect on total mortality.
该研究旨在评估急性心肌梗死后为期3年的综合康复与二级预防计划对死亡率的长期影响。研究组由375例65岁以下连续入选的非特定患者组成，这些患者被随机分配至干预组（188例患者）或对照组（187例患者）。经过15年的随访，与对照组相比，干预组的猝死发生率（16.5%对28.9%，P = 0.006）和冠状动脉死亡率（47.9%对58.5%，P = 0.04）显著降低。总死亡率分别为64.4%和66.8%（无统计学差异）。干预组癌症死亡发生率为16例，对照组为3例。心力衰竭、心脏扩大、纽约心脏协会功能分级为II级或更高以及属于对照组在最初3年内与冠状动脉死亡率显著相关，3年后心脏扩大、糖尿病和再梗死与晚期冠状动脉死亡相关。因此，急性心肌梗死后的综合多因素干预对冠状动脉死亡率和猝死有良好的长期影响，但对总死亡率无影响。
