再灌流時代における急性心筋梗塞症例の予後規定因子の検討

概要

論文の詳細を見る
Background: In the present acute reperfusion era, only a few studies have followed up Japanese patients with acute myocardial infarctions (AMIs), and evaluated the long-term prognosis. Objectives and Methods: To determine the long-term prognosis and prognostic factors in Japanese patients with AMIs, a prospective cohort study was conducted, with 3,021 consecutive patients with AMIs prospectively enrolled. Results: During the index hospitalization, coronary angioplasty and coronary thrombolysis were performed in 58.1 and 16.3% of patients, respectively. In total 2,736 patients (90.6%) were discharged alive and followed up for a mean of 4.2 years (follow-up rate, 97.0%). Among them, 12.8% died. Multivariate analysis revealed that diabetes mellitus and an older age of onset of the AMI were independent poor prognostic factors [hazard ratio (HR): 1.59 and 2.84, respectively]. There was no significant association between their late outcome and hypertension or medication with calcium antagonists, nitrates, or beta-blockers (HR: 1.20, 1.03,1.16 and 0.95, respectively). The use of angiotensin-converting enzyme inhibitors was significantly associated with a favorable outcome (HR: 0.65). Conclusion: Although Japanese patients with AMIs are treated aggressively and have favorable long-term prognoses, there is room for improvement in the drug therapy and measures of comorbidities known to be coronary risk factors.
東京女子医科大学の論文