Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion

BMC Cardiovascular Disorders

Research Article

Víctor Bazán¹  Neus Salvatella²  Julio Martí-Almor²  Lluís Recasens²  Jordi Bruguera²  Oona Meroño²  Núria Ribas³  Cosme García-García⁴  Silvia Pérez-Fernández⁵  Roberto Elosua⁵ 

[1] Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain;Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain;Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain;Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain;Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain;Medicine Department, Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain;Hospital Universitari Germans Trias i Pujol, Badalona, Spain;IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain;CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain;

关键词: ST-segment elevation myocardial infarction;    Coronary angioplasty;    Secondary prevention;    Prognosis;    Reperfusion therapy;    Cardiovascular risk factors;   

DOI  :  10.1186/s12872-017-0493-6

 received in 2016-11-23, accepted in 2017-02-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry.Design and methodsFour hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors.ResultsA total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11–30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates.ConclusionsWhereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.

【 授权许可】

CC BY   
© The Author(s). 2017