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ȣ - 540891 149 |
| The impact of revascularization and optimal medical therapy on six-month clinical outcome in patients with and without congestive heart failure after acute myocardial infarction from the Korea Acute Myocardial Infarction Registry |
| 경북대학교병원 순환기 내과¹ , 영남대학교 순환기 내과²,전남대학교 순환기 내과³ , 대구가톨릭대학교 순환기 내과⁴ , 계명대학교 순환기 내과5 , 충남대학교 순환기 내과6 , 부산대학교 순환기 내과7 , 충북대학교 순환기 내과8 ,경희대학교 동서 신의학 병원9 |
| 이장훈¹, 채성철¹ , 박선희¹ , 강정규¹ , 김나영¹ , 양동헌¹ , 박헌식¹ , 조용근¹ , 전재은¹ , 박의현 ¹ , 김영조² , 정명호³ , 김기식⁴ ,허승호5 ,성인환6 , 홍택종7 , 조명찬8 , 김종진9 |
Background: The aims of this study were to determine the interactive effect of revascularization and optimal medical therapy (OMT) in patients with acute myocardial infarction (AMI) complicated by congestive heart failure (CHF) on 6-month major adverse cardiac events (MACE). Methods: Between November 2005 and January 2008, 14,871 patients suspected AMI were included from the Korea AMI Registry, and 9,470 patients (6,649 men; mean age = 63.0 ± 12.5 years-old) followed up 6-month were finally analyzed. Of these patients, 2,595 (27.4%) patients had CHF (Killip class II-IV) at presentation. The 6-month MACE was defined as death, nonfatal MI, and revascularization. Results: Overall, 8,146 (86.0%) patients underwent revascularization and 4,657 (49.2%) patients received OMT. Patients were categorized into 4 groups based on treatment modalities; revascularization and OMT. The patients underwent revascularizatoin and received OMT had the lowest 6-month MACE (6.1%), whereas non-revascularized and non-OMT patients had the highest 6-month MACE (33.4%). The revascularized and non-OMT patients had significantly lower 6-month MACE compared with the non-revascularized and OMT patients (14.0% versus 24.3%, p<0.001). Among non-CHF, compared with revascularized and OMT group, there was no significant difference in 6-month MACE in revascularized and non-OMT group (adjusted hazard ratio [HR] 1.235, 95% confidence interval [CI] 0.967 to 1.578, p=0.091), whereas non-revascularized and OMT group had significantly higher 6-month MACE (adjusted HR 2.437, 95% CI 1.416 to 4.197, p=0.001). Among CHF patients, compared with revascularized and OMT group, there was no significant difference in 6-month MACE in non-revascularized and OMT group (adjusted HR 1.721, 95% CI 0.953 to 3.111, p=0.072), whereas revascularized and non-OMT group had significantly higher 6-month MACE (adjusted HR 1.408, 95% CI 1.026 to 1.931, p=0.034). Conclusion: This observational study suggest that lower use of revascularization in non-CHF patients and lower use of OMT in CHF patients are associated with 6-month MACE in post-MI patients.
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