Effect of Angiotensin-Converting Enzyme Inhibition on One-Year Mortality and Frequency of Repeat Acute Myocardial Infarction in Patients With Acute Myocardial Infarction
Effect of Angiotensin-Converting Enzyme Inhibition on One-Year Mortality and Frequency of Repeat Acute Myocardial Infarction in Patients With Acute Myocardial Infarction
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DOI：
10.1016/j.amjcard.2009.12.032
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发表时间：
2010-05-01
影响因子：
2.8
通讯作者：
Stenestrand, Ulf
中科院分区：
文献类型：
--
作者：
Milonas, Christos;Jernberg, Tomas;Stenestrand, Ulf
关于是否所有急性心肌梗死（AM！）血管紧张素转换酶抑制剂（ACEI）。我们研究了ACEI治疗与大量AMI患者死亡率之间的关系。本研究纳入了105，224例入院时未接受ACEI治疗的AMI患者。逻辑回归分析，包括33个变量，计算了每例患者的倾向评分，以估计在出院时接受ACEI的概率，给定的背景。出院时ACEI治疗与1年预后之间的相关性在预先设定的亚组中采用考克斯回归分析进行评价，调整出院时的倾向评分和药物。共有38，395例患者（36.5%）在出院时接受了ACEI治疗。校正后，ACEI治疗与死亡率降低24%相关（相对危险度0.76，95%可信区间0.73 - 0.80）。在有心力衰竭病史或目前有心力衰竭迹象的患者中获益最大。在无心力衰竭的患者中，ACEI治疗的显著获益仅见于肾功能不全患者（相对危险度0.69，95%可信区间0.54 - 0.88）。在整个组中，AMI的风险降低了7%（相对风险0.93，95%置信区间0.90至0.96），在ST段抬高AMI或收缩期左心室功能不全的患者中观察到更大的效果。总之，ACEI治疗可降低AMI患者1年死亡率（主要是心力衰竭或肾功能不全患者），并可小幅降低再梗死风险（主要是ST段抬高AMI或收缩期左室功能不全患者）。(C)2010年爱思唯尔公司All rights reserved. (Am J Cardiol 2010;105：1229-1234）
Controversy exists regarding whether all patients with acute myocardial infarction (AM!) benefit from angiotensin-converting enzyme inhibitors (ACEIs). We examined the association between ACEI treatment and mortality in a large, unselected population of patients with AMI. The present study included 105,224 patients with AMI who were not treated with ACEIs on admission. A logistic regression analysis, including 33 variables, calculated a propensity score for each patient to estimate the probability of receiving ACEIs at discharge, given the background. The association between ACEI treatment at discharge and the 1-year outcome was evaluated in prespecified subgroups using the Cox regression analyses, adjusting for the propensity score and medications at discharge. A total of 38,395 patients (36.5%) received ACEIs at discharge. After adjustment, ACEI treatment was associated with a 24% reduction in mortality (relative risk 0.76, 95% confidence interval 0.73 to 0.80). The benefit was largest in patients with a history or present signs of heart failure. In patients without heart failure, a significant benefit of ACEI treatment was seen only in patients with renal dysfunction (relative risk 0.69, 95% confidence interval 0.54 to 0.88). In the whole group, the risk of AMI decreased by 7% (relative risk 0.93, 95% confidence interval 0.90 to 0.96), with a larger effect seen in patients with ST-segment elevation AMI or systolic left ventricular dysfunction. In conclusion, in unselected patients with AMI, ACEI treatment was associated with a reduction in 1-year mortality, mainly in patients with heart failure or renal dysfunction, and a small reduction in the risk of reinfarction, mainly in patients with ST-segment elevation AMI or systolic left ventricular dysfunction. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1229-1234)