Comparison of Long-Term Mortality After Percutaneous Coronary Intervention in Patients Treated for Acute ST-Elevation Myocardial Infarction Versus Those With Unstable and Stable Angina Pectoris
Comparison of Long-Term Mortality After Percutaneous Coronary Intervention in Patients Treated for Acute ST-Elevation Myocardial Infarction Versus Those With Unstable and Stable Angina Pectoris
复制标题
DOI：
10.1016/j.amjcard.2009.03.052
复制
发表时间：
2009-08-01
影响因子：
2.8
通讯作者：
de Winter, Robbert J.
中科院分区：
文献类型：
--
作者：
Hirsch, Alexander;Verouden, Niels J. W.;de Winter, Robbert J.
关于具有不同经皮冠状动脉介入治疗（PCI）指征的患者范围内的长期死亡率比较的数据仍然有限。我们评估了接受直接 PCI 治疗的 ST 段抬高型心肌梗死 (STEMI) 患者的早期和晚期死亡率，与因不稳定型心绞痛 (UA) 或非 STEMI (NSTEMI) 和稳定型心绞痛接受 PCI 的患者的早期和晚期死亡率进行比较。对 1997 年至 2005 年在同一机构连续接受 PCI 的总共 10,549 名患者进行了前瞻性随访（中位时间 3.2 年，四分位距 1.5 至 5.6），以评估全因死亡率。 PCI 的适应症为 STEMI（28%）、UA/NSTEMI（32%）和稳定型心绞痛（40%）。 STEMI 患者的 6 年死亡率为 18.9%，UA/NSTEMI 患者的 6 年死亡率为 16.2%，稳定型心绞痛患者的 6 年死亡率为 11.7%。在最初 6 个月内，与 UA/NSTEMI 患者（相对风险 [RR] 3.09，95% 置信区间 [CI] 2.46 至 3.89）和稳定型心绞痛（RR 5.82，95% CI 4.45 至 7.62）患者相比，STEMI 患者的死亡风险增加。然而，在 6 个月至 6 年间，STEMI 患者和稳定型心绞痛患者的死亡率几乎相似（RR 1.06，95% CI 0.86 至 1.32），而 UA/NSTEMI 患者的死亡率最高（UA/NSTEMI 与稳定型心绞痛：RR 1.33，95% CI 1.11 至 1.58；STEMI 与 UA/NSTEMI 患者： RR 0.80， 95% CI 0.65 至 0.99）。总之，我们已经证明 STEMI 患者直接 PCI 后生存率较低主要归因于事件发生后头几个月的死亡率较高。这些观察结果强调，新的辅助治疗策略应以降低直接 PCI 后头几个月的死亡率为目标。 (C) 2009 Elsevier Inc. 保留所有权利。 (Am J Cardiol 2009;104:333-337)
Data remain limited regarding the comparative long-term mortality across the spectrum of patients with different indications for percutaneous coronary intervention (PCI.). We evaluated early and late mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI compared with early and late mortality in patients undergoing PCI for unstable angina (UA) or non-STEMI (NSTEMI) and stable angina. A total of 10,549 consecutive patients undergoing PCI from 1997 to 2005 at a single institution were followed up prospectively (median 3.2 years, interquartile range 1.5 to 5.6) to assess all-cause mortality. The indication for PCI was STEMI in 28%, UA/NSTEMI in 32%, and stable angina in 40%. The mortality rate at 6 years was 18.9% in patients with STEMI, 16.2% in patients with UA/NSTEMI, and 11.7% in those with stable angina. During the initial 6 months, patients with STEMI had an increased risk of death compared with patients with UA/NSTEMI (relative risk [RR] 3.09, 95% confidence interval [CI] 2.46 to 3.89) and stable angina (RR 5.82, 95% CI 4.45 to 7.62). However, between 6 months and 6 years, mortality accrued at an almost similar rate among patients with STEMI and those with stable angina (RR 1.06, 95% CI 0.86 to 1.32) and mortality was greatest in patients with UA/NSTEMI (UA/NSTEMI vs stable angina: RR 1.33, 95% CI 1.11 to 1.58; STEMI vs UA/NSTEMI: RR 0.80, 95% CI 0.65 to 0.99). In conclusion, we have demonstrated that the inferior survival rates in patients with STEMI after primary PCI are mainly attributed to greater mortality in the first months after the event. These observations highlight that new adjunctive therapeutic strategies should aim at mortality reduction in the first months after primary PCI. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:333-337)