Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge
Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge
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DOI：
10.1016/j.jacc.2007.10.063
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发表时间：
2008-04-01
影响因子：
24
通讯作者：
Winkelmayer, Wolfgang C.
中科院分区：
文献类型：
--
作者：
Setoguchi, Soko;Glynn, Robert J.;Winkelmayer, Wolfgang C.
目的：我们试图评估增加使用心血管药物与老年人心肌梗死（MI）后长期预后趋势之间的关系。背景：在过去的十年中，他汀类药物、β受体阻滞剂（BB）、血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II受体阻滞剂（ARB）在MI后的使用越来越多。然而，鲜为人知的是，越来越多地使用这些药物和改善预后后MI。方法使用数据从药房援助计划和医疗保险在2个州（1995年至2004年），我们确定了MI患者出院后生存>= 30天。我们评估了MI住院期间的年龄、性别、种族、合并症和冠状动脉介入治疗，并记录了出院后30天内他汀类药物、BB、ACEI/ARB或抗血小板药物的处方。对所有患者进行跟踪，直至其死亡或直至合格性/研究期结束。我们建立了多变量考克斯比例风险回归模型，以评估长期死亡率的趋势和MI后药物使用增加的贡献。在调整人口统计学和合并症后，我们发现MI后的死亡率从1995年到2004年显著下降（年度趋势的风险比为0.97; 95%置信区间为0.97 - 0.98），每年死亡率下降3%。调整使用他汀类药物，BB，ACEI/ARB，抗血小板药物出院后完全消除了时间趋势和死亡率之间的关联（风险比1.00; 95%置信区间0.99至1.01）。结论观察到的改善，在老年MI患者的长期死亡率可能主要是由于出院后增加使用心血管药物。
Objectives We sought to assess the relationship between increasing use of cardiovascular medications and trends in longterm prognosis after myocardial infarction (MI) in the elderly.Background During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI.Methods Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived >= 30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI.Results Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01).Conclusions The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.