Survival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI.
Survival After MI in a Community Cohort Study: Contribution of Comorbidities in NSTEMI.
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DOI：
10.1016/j.gheart.2018.01.002
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发表时间：
2018-03
期刊：
影响因子：
3.7
通讯作者：
Raman SV
中科院分区：
文献类型：
--
作者：
Foraker RE;Guha A;Chang H;O'Brien EC;Bower JK;Crouser ED;Rosamond WD;Raman SV
非ST段抬高型心肌梗死（NSTEMI）占全球MI的大多数，但死亡率仍然很高。与ST段抬高型心肌梗死的“时间就是肌肉”方法相比，NSTEMI的管理相对延迟和异质性，尽管尚不清楚共病疾病在多大程度上导致NSTEMI死亡。我们试图量化非ST段抬高型心肌梗死（NSTEMI）患者因心肌梗死和合并症导致的死亡率。ARIC（社区动脉粥样硬化风险）研究队列的参与者年龄为45至64岁，他们发生了NSTEMI事件，并按年龄组、性别、种族和研究社区将其发病率密度与未发生MI的参与者相匹配。我们估计了全因死亡率的风险比，将发生NSTEMI的患者与未发生MI的患者进行比较。发生NSTEMI的ARIC参与者在基线时更有可能是吸烟者，患有糖尿病和肾功能不全，并服用血压或降胆固醇药物，而不是没有MI的参与者。超过一半的NSTEMI参与者在中位随访8.4年后死亡;调整合并症后，NSTEMI事件与死亡风险增加30%相关（风险比：1.30; 95%置信区间：1.11至1.53）。非ST段抬高型心肌梗死（NSTEMI）的死亡风险显著高于合并症。需要更一致和有效的策略来降低NSTEMI合并症的死亡率。
Non–ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the “time is muscle” approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality. We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI. Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI. ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53). NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions.
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