在当代再灌注时代,重新评估 STEMI 患者出院时接受 ACEI/ARB 治疗的效果。

IF 3.7 3区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Mengjin Hu, Chuangshi Wang, Jingang Yang, Xiaojin Gao, Yuejin Yang
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引用次数: 0

摘要

背景:在再灌注前或溶栓时代,血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)对ST段抬高型心肌梗死(STEMI)患者的临床预后有益。目前尚不清楚在当代再灌注时代这种益处是否仍然存在:我们试图确定在当代再灌注时代,ACEI/ARB 是否能根据再灌注策略改善 STEMI 患者的临床预后。方法:我们从前瞻性、全国性、多中心的中国急性心肌梗死(CAMI)登记中分析了 12596 例患者。这些患者被分为无再灌注组(6004 人)和主要经皮冠状动脉介入治疗(PCI)组(6592 人)。比较了两年全因死亡率和主要不良心脑血管事件(MACCE):结果:在无再灌注组,出院时接受 ACEI/ARB 治疗可降低 30 天 MACCE 的发生率(4.7% vs 7.4%;调整后危险比 [HR]:0.67;95% 置信区间 [CI]:0.53-0.85;PC结论:出院时接受 ACEI/ARB 治疗可减少未接受再灌注的 STEMI 患者的心血管事件,而在接受初级 PCI 的患者中未观察到明显的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reevaluate the effect of ACEI/ARB therapy at discharge on patients with STEMI in the contemporary reperfusion era.

Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) had beneficial effects on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the pre-reperfusion or thrombolytic era. It is unknown if the benefits persist in the contemporary reperfusion era.

Objectives: We sought to determine if ACEI/ARB improves clinical outcomes of patients with STEMI in the contemporary reperfusion era according to the reperfusion strategy.

Methods: 12596 patients were analyzed from the prospective, nationwide, multicenter China Acute Myocardial Infarction (CAMI) Registry. These patients were classified into the no reperfusion group (n=6004) and the primary percutaneous coronary intervention (PCI) group (n=6592). Two-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) were compared.

Results: In the no reperfusion group, ACEI/ARB therapy at discharge may reduce the incidences of 30-day MACCE (4.7% vs 7.4%; adjusted hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.53-0.85; P<0.001), stroke (0.5% vs 1.1%; adjusted HR: 0.41; 95% CI: 0.21-0.83; P=0.01), and revascularization (2.1% vs 3.1%; adjusted HR: 0.66; 95% CI: 0.46-0.94; P=0.02) compared to patients not treated with ACEI/ARB. Patients treated with ACEI/ARB also showed a lower rate of two-year MACCE (17.0% versus 19.1%; adjusted HR: 0.87; 95% CI: 0.76-0.99; P=0.04). No differences were observed in the remaining outcomes. In the primary PCI group, no differences were observed for all examined outcomes before and after multivariate adjustments.

Conclusions: Treatment with ACEI/ARB at discharge may reduce cardiovascular events in STEMI patients not receiving reperfusion, while no significant benefits were observed in those receiving primary PCI.

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来源期刊
Kardiologia polska
Kardiologia polska 医学-心血管系统
CiteScore
3.00
自引率
24.20%
发文量
431
审稿时长
3-6 weeks
期刊介绍: Kardiologia Polska (Kardiol Pol, Polish Heart Journal) is the official peer-reviewed journal of the Polish Cardiac Society (PTK, Polskie Towarzystwo Kardiologiczne) published monthly since 1957. It aims to provide a platform for sharing knowledge in cardiology, from basic science to translational and clinical research on cardiovascular diseases.
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