Contemporary Trends in Heart Failure With Reduced and Preserved Ejection Fraction After Myocardial Infarction: A Community Study
Contemporary Trends in Heart Failure With Reduced and Preserved Ejection Fraction After Myocardial Infarction: A Community Study
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DOI：
10.1093/aje/kwt109
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发表时间：
2013-10-15
影响因子：
5
通讯作者：
Roger, Veronique L.
中科院分区：
文献类型：
--
作者：
Gerber, Yariv;Weston, Susan A.;Roger, Veronique L.
最近，心肌梗死(MI)的流行病学发生了重大变化，可能会影响心力衰竭(HF)等预后。描述心梗后心衰趋势的数据很少，而且相互矛盾，并且没有区分保留和减少的射血分数(EF)。我们评估了心梗后心衰的时间趋势。所有明尼苏达州奥姆斯特德县(n 2,596)的居民在19902010被诊断为首次心肌梗死，之前没有心力衰竭的患者都被随访到2012年。使用Framingham心脏研究标准来定义心衰，并根据EF进一步分类。对早发性心力衰竭(心梗后07天)和晚发性心力衰竭(心梗后8天至5年)进行检查。患者表现的变化被记录下来，包括ST段抬高失误减少，Killip分级降低，以及更多的合并情况。在5年的随访期内，715名患者发生了心力衰竭，其中475人在第一周发生。年龄和性别调整后的风险从19901996下降到20042010，早发心衰的危险比为0.67(95可信区间：0.54，0.85)，晚发心衰的危险比为0.63(95可信区间：0.45，0.86)。进一步调整患者和心肌梗死的特征，得出早发性和晚发性心力衰竭的危险比分别为0.86(95可信区间：0.66，1.11)和0.63(95可信区间：0.45，0.88)。EF降低的心衰患者早发和晚发心衰的发生率下降(50)，而EF保留的心衰患者则未见下降，这表明心梗后心衰的病例组合发生了变化，需要新的预防策略。
Major changes have recently occurred in the epidemiology of myocardial infarction (MI) that could possibly affect outcomes such as heart failure (HF). Data describing trends in HF after MI are scarce and conflicting and do not distinguish between preserved and reduced ejection fraction (EF). We evaluated temporal trends in HF after MI. All residents of Olmsted County, Minnesota (n 2,596) who had a first-ever MI diagnosed in 19902010 and no prior HF were followed-up through 2012. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Both early-onset (07 days after MI) and late-onset (8 days to 5 years after MI) HF were examined. Changes in patient presentation were noted, including fewer ST-segmentelevation MIs, lower Killip class, and more comorbid conditions. Over the 5-year follow-up period, 715 patients developed HF, 475 of whom developed it during the first week. The age- and sex-adjusted risk declined from 19901996 to 20042010, with hazard ratios of 0.67 (95 confidence interval (CI): 0.54, 0.85) for early-onset HF and 0.63 (95 CI: 0.45, 0.86) for late-onset HF. Further adjustment for patient and MI characteristics yielded hazard ratios of 0.86 (95 CI: 0.66, 1.11) and 0.63 (95 CI: 0.45, 0.88) for early- and late-onset HF, respectively. Declines in early-onset and late-onset HF were observed for HF with reduced EF (50) but not for HF with preserved EF, indicating a change in the case mix of HF after MI that requires new prevention strategies.