ST上昇と非ST上昇の心筋梗塞のために心臓キャセテリゼーションを受けている患者の長期的な死亡率
Mark Y Chan1, Jie L Sun, L Kristin Newby
1MBBS, MHS, National University Heart Center, 5 Lower Kent Ridge Road, Singapore, Singapore 119074. chanyymark@gmail.com
Circulation
|June 10, 2009
まとめ
STセグメント上昇心筋梗塞 (STEMI) は短期的な死亡リスクが高く,非STEMI (NSTEMI) は長期的な死亡リスクが高くなります. 早期の再血管化は,STEMIとNSTEMIの両方の患者のアウトカムを改善します.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- クリニカル・アウトカム・リサーチ 研究結果
背景:
- STセグメント上昇心筋梗塞 (STEMI) と非STEMI (NSTEMI) に対する心臓キャセテリゼーション後の長期的なアウトカムを比較する現代のデータは限られている.
- 介入のリスクと利益の違いを理解することは,急性心筋梗塞 (AMI) の管理に不可欠です.
研究 の 目的:
- 心臓キャセテリゼーションを受けるSTEMIとNSTEMI患者の長期的な死亡率を比較する.
- STEMI患者とNSTEMI患者の死亡率に対する早期再血管化の影響を評価する.
主な方法:
- 重大な冠動脈病変を患った4387人の患者の遡及的分析で,心臓のキャセテリゼーション (1999-2005) を受けた.
- 調整された死亡率の比較を時間とともに,断片分析を用いて行う.
- STEMIとNSTEMIのコホートにおける死亡率に対する早期再血管化の効果の分層分析.
主要な成果:
- STEMI患者は,NSTEMIと比較して,調整された短期死亡リスク (最初の2ヶ月) が高かった.
- NSTEMI患者は2ヶ月後に低調整された長期的な死亡リスクを示した.
- 早期の再血管化は,STEMIとNSTEMIの両グループで死亡率調整リスクの低下と関連しており,有意な相互作用はありませんでした.
結論:
- STEMIは,より高い短期死亡率と関連しているが,NSTEMIは,冠動脈疾患の急性MI患者の長期的な死亡率の増加と関連している.
- 早期再血管化は,STEMIとNSTEMIの両方にとって,長期生存上の利益を比較することができます.
- 治療の効果を検出するためにNSTEMIにおける早期再血管化を調査する臨床試験では,延長されたフォローアップが推奨されます.
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