st段抬高与非st段抬高心肌梗死一年预后差异及治疗策略：来自PRAISE注册表的见解

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2025-06-24 DOI:10.1007/s40256-025-00739-8

Luigi Spadafora, Paola Pastena, Stefano Cacciatore, Matteo Betti, Giuseppe Biondi-Zoccai, Fabrizio D'Ascenzo, Gaetano Maria De Ferrari, Ovidio De Filippo, Francesco Versaci, Sebastiano Sciarretta, Giacomo Frati, Francesco Fiorentino, Marco Borgi, Nicola Pierucci, Pierre Sabouret, Francesco Ajmone, Attilio Lauretti, Federico Russo, Alberto Polimeni, Maciej Banach, Giorgia Panichella, Marco Bernardi

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引用次数: 0

摘要

st段抬高型心肌梗死（STEMI）和非st段抬高型心肌梗死（NSTEMI）在出院后是否具有不同的预后仍然存在争议。本研究旨在比较STEMI和NSTEMI患者在现实世界中1年的临床结果。方法：在2003年至2019年期间，在国际PRAISE登记的23,270例急性冠状动脉综合征患者中，我们纳入了21,789例诊断为STEMI或NSTEMI的患者。分析1年的临床特征、出院药物和结局。主要结局是全因死亡率、再梗死和大出血。采用多变量逻辑回归和倾向评分匹配来调整混杂因素。还进行了亚组分析和相互作用分析。结果：该队列包括12365例STEMI患者和9424例非STEMI患者。在基线时，NSTEMI患者有更多的合并症、心血管危险因素（糖尿病除外）和先前的血运重建术。STEMI患者在出院时更常使用他汀类药物、受体阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂。在1年的随访中，两组之间的总体结果具有可比性。非致死性再梗死在非stemi患者中发生率更高（3.4%对2.8%,p = 0.022），但调整后这种关联不显著（优势比[OR] 0.90, 95%可信区间[CI] 0.65-1.24, p = 0.519）。倾向评分匹配分析的结果证实没有预后差异。亚组分析显示糖尿病与血运重建的完整性有显著的相互作用。结论：在考虑了临床和治疗变量后，STEMI和NSTEMI患者的1年预后基本相似。再梗死风险的差异似乎是由基线特征和治疗模式驱动的，而不是梗死类型本身。

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One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial Infarction: Insights from the PRAISE Registry.

Introduction: Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

Methods: Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.

Results: The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.

Conclusions: After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.