Long-Term Cardiovascular Mortality After Procedure-Related or Spontaneous Myocardial Infarction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome A Collaborative Analysis of Individual Patient Data From the FRISC II, ICTUS, and RITA-3 Trials (FIR)
Long-Term Cardiovascular Mortality After Procedure-Related or Spontaneous Myocardial Infarction in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome A Collaborative Analysis of Individual Patient Data From the FRISC II, ICTUS, and RITA-3 Trials (FIR)
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DOI：
10.1161/circulationaha.111.061663
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发表时间：
2012-01-31
期刊：
影响因子：
37.8
通讯作者：
de Winter, Robbert J.
中科院分区：
文献类型：
--
作者：
Damman, Peter;Wallentin, Lars;de Winter, Robbert J.
背景-本研究旨在调查非ST段抬高急性冠状动脉综合征患者手术相关性和自发性心肌梗死（MI）对心血管死亡率的长期预后影响。方法和结果-在FRISC-II的个体患者汇总数据集中调查了手术相关性或自发性MI后的5年随访。（冠状动脉疾病不稳定期间的快速血运重建）、ICTUS（不稳定型冠状动脉综合征的侵入性与保守性治疗）和RITA-3（不稳定型心绞痛随机干预试验3）非ST段抬高急性冠状动脉综合征试验。主要结局是随访5年的心血管死亡。采用Kaplan-Meier法估计累积事件发生率;采用时间依赖性考克斯比例风险模型计算风险比。对与长期结果相关的变量进行了调整。在5467例患者中，212例在入组后6个月内发生了手术相关MI。236例患者在6个月内发生自发性MI。发生手术相关MI的患者的累积心血管死亡率为5.2%，与未发生手术相关MI的患者相当（风险比0.66; 95%置信区间，0.36-1.20，P=0.17）。在6个月内发生自发性MI的患者中，累积心血管死亡率为22.2%，高于无自发性MI的患者（风险比4.52; 95%置信区间，3.37-6.06，P
Background-The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome.Methods and Results-Five-year follow-up after procedure-related or spontaneous MI was investigated in the individual patient pooled data set of the FRISC-II (Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Intervention Trial of Unstable Angina 3) non-ST-elevation acute coronary syndrome trials. The principal outcome was cardiovascular death up to 5 years of follow-up. Cumulative event rates were estimated by the Kaplan-Meier method; hazard ratios were calculated with time-dependent Cox proportional hazards models. Adjustments were made for the variables associated with long-term outcomes. Among the 5467 patients, 212 experienced a procedure-related MI within 6 months after enrollment. A spontaneous MI occurred in 236 patients within 6 months. The cumulative cardiovascular death rate was 5.2% in patients who had a procedure-related MI, comparable to that for patients without a procedure-related MI (hazard ratio 0.66; 95% confidence interval, 0.36-1.20, P=0.17). In patients who had a spontaneous MI within 6 months, the cumulative cardiovascular death rate was 22.2%, higher than for patients without a spontaneous MI (hazard ratio 4.52; 95% confidence interval, 3.37-6.06, P