Long-Term Mortality of Patients Undergoing Cardiac Catheterization for ST-Elevation and Non-ST-Elevation Myocardial Infarction
Long-Term Mortality of Patients Undergoing Cardiac Catheterization for ST-Elevation and Non-ST-Elevation Myocardial Infarction
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DOI：
10.1161/circulationaha.108.799981
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发表时间：
2009-06-23
期刊：
影响因子：
37.8
通讯作者：
Roe, Matthew T.
中科院分区：
文献类型：
--
作者：
Chan, Mark Y.;Sun, Jie L.;Roe, Matthew T.
背景-比较ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）心导管术后长期结果的当代数据有限。方法和结果-我们研究了1999年至2005年间因STEMI（n = 2413）和非ST段抬高型心肌梗死（n = 1974）接受心导管术的患者，其中至少有1处显著冠状动脉病变≥ 75%。我们比较了在限定时间间隔内校正的死亡率和早期血运重建对按ST段抬高状态分层的死亡率的不同影响。1999年至2007年，1274名患者死亡，中位随访时间为4年。分段分析显示，前2个月内STEMI的校正死亡风险较高（校正风险比，1.85; 95%置信区间，1.45至2.38），2个月后STEMI的校正死亡风险较低（校正风险比，0.68; 95%置信区间，0.59至0.83）。与晚期或无血运重建相比，早期血运重建与两种STEMI的校正死亡风险较低相关。（校正的风险比，0.73; 95%置信区间，0.58 - 0.90）和NSTEMI（调整后的风险比，0.76; 95%置信区间，0.65至0.89）（相互作用P = 0.22）.结论-在心导管插入术期间有显著冠状动脉疾病的急性心肌梗死患者的当代队列中，STEMI与短期死亡风险较高相关，但NSTEMI与长期死亡风险较高相关。早期血运重建与STEMI和NSTEMI的长期结局改善相似。这些数据表明，在NSTEMI患者早期血运重建的临床研究中，可能需要延长随访以证明治疗获益。（循环。2009; 119：3110-3117）。
Background-There are limited contemporary data comparing long-term outcomes after cardiac catheterization for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).Methods and Results-We studied patients undergoing cardiac catheterization for STEMI (n = 2413) and NSTEMI (n = 1974) between 1999 and 2005 with at least 1 significant coronary lesion >= 75%. We compared adjusted mortality rates over restricted time intervals and the differential impact of early revascularization on mortality stratified by ST-elevation status. Between 1999 and 2007, 1274 patients died, with a median follow-up of 4 years. A piece-wise analysis showed a higher adjusted mortality risk for STEMI during the first 2 months (adjusted hazard ratio, 1.85; 95% confidence interval, 1.45 to 2.38) and a lower adjusted mortality risk for STEMI after 2 months (adjusted hazard ratio, 0.68; 95% confidence interval, 0.59 to 0.83). Compared with late or no revascularization, early revascularization was associated with a lower adjusted risk of mortality for both STEMI (adjusted hazard ratio, 0.73; 95% confidence interval, 0.58 to 0.90) and NSTEMI (adjusted hazard ratio, 0.76; 95% confidence interval, 0.65 to 0.89) (P for interaction = 0.22).Conclusions-Among a contemporary cohort of acute MI patients with significant coronary disease during cardiac catheterization, STEMI was associated with a higher risk of short-term mortality, but NSTEMI was associated with a higher risk of long-term mortality. Early revascularization was associated with a similar improvement in long-term outcomes for both STEMI and NSTEMI. These data suggest that in clinical investigations of early revascularization among patients with NSTEMI, extended follow-up may be necessary to demonstrate treatment benefit. (Circulation. 2009; 119: 3110-3117.)