10-Year Mortality After ST-Segment Elevation Myocardial Infarction Compared to the General Population,Journal of the American College of Cardiology

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10-Year Mortality After ST-Segment Elevation Myocardial Infarction Compared to the General Population
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2024-06-17 , DOI: 10.1016/j.jacc.2024.04.025
Pernille Gro Thrane ₁ , Kevin Kris Warnakula Olesen ₁ , Troels Thim ₁ , Christine Gyldenkerne ₁ , Malene Kærslund Hansen ₁ , Nina Stødkilde-Jørgensen ₁ , Lars Jakobsen ₁ , Martin Bødtker Mortensen ₁ , Steen Dalby Kristensen ₂ , Michael Maeng ₂

Affiliation

ST-segment elevation myocardial infarction (STEMI) is associated with high early mortality. However, it remains unclear if patients surviving the early phase have long-term excess mortality. This study aims to assess excess mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI) compared with an age- and- sex-matched general population at landmark periods 0 to 30 days, 31 to 90 days, and 91 days to 10 years. Using the Western Denmark Heart Registry, we identified first-time PCI-treated patients who had primary PCI for STEMI from January 2003 to October 2018. Each patient was matched by age and sex to 5 individuals from the general population. We included 18,818 patients with first-time STEMI and 94,090 individuals from the general population. Baseline comorbidity burden was similar in STEMI patients and matched individuals. Compared with the matched individuals, STEMI was associated with a 5.9% excess mortality from 0 to 30 days (6.0% vs 0.2%; HR: 36.44; 95% CI: 30.86-43.04). An excess mortality remained present from 31 to 90 days (0.9% vs 0.4%; HR: 2.43; 95% CI: 2.02-2.93). However, in 90-day STEMI survivors, the absolute excess mortality was only 2.1 percentage points at 10-year follow-up (26.5% vs 24.5%; HR: 1.04; 95% CI: 1.01-1.08). Use of secondary preventive medications such as statins, antiplatelet therapy, and beta-blockers was very high in STEMI patients throughout 10-year follow-up. In primary PCI-treated STEMI patients with high use of guideline-recommended therapy, patients surviving the first 90 days had 10-year mortality that was only 2% higher than that of a matched general population.

中文翻译：

ST 段抬高型心肌梗死后 10 年死亡率与普通人群的比较

ST 段抬高型心肌梗死 (STEMI) 与高早期死亡率相关。然而，尚不清楚早期存活的患者是否具有长期超额死亡率。本研究旨在评估接受直接经皮冠状动脉介入治疗 (PCI) 治疗的 STEMI 患者与年龄和性别匹配的一般人群相比，在 0 至 30 天、31 至 90 天和 91 天至 10 年的标志性时期的超额死亡率。利用丹麦西部心脏登记处，我们确定了 2003 年 1 月至 2018 年 10 月期间首次接受 PCI 治疗的 STEMI 初次 PCI 患者。每位患者均按年龄和性别与普通人群中的 5 名患者进行匹配。我们纳入了 18,818 名首次 STEMI 患者和 94,090 名普通人群。 STEMI 患者和匹配个体的基线合并症负担相似。与匹配个体相比，STEMI 与 0 至 30 天死亡率增加 5.9% 相关（6.0% vs 0.2%；HR：36.44；95% CI：30.86-43.04）。 31 至 90 天期间死亡率仍然过高（0.9% vs 0.4%；HR：2.43；95% CI：2.02-2.93）。然而，在 90 天的 STEMI 幸存者中，10 年随访时绝对超额死亡率仅为 2.1 个百分点（26.5% vs 24.5%；HR：1.04；95% CI：1.01-1.08）。在 10 年的随访中，STEMI 患者使用他汀类药物、抗血小板治疗和 β 受体阻滞剂等二级预防药物的比例非常高。在初次 PCI 治疗且大量使用指南推荐治疗的 STEMI 患者中，存活前 90 天的患者 10 年死亡率仅比匹配的一般人群高 2%。

更新日期：2024-06-17

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