期刊
EUROPEAN HEART JOURNAL
卷 35, 期 35, 页码 2363-+出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehu286
关键词
Myocardial infarction; Epidemiology; Ischaemia
资金
- UK National Institute for Health Research [RP-PG-0407-10314]
- Wellcome Trust [086091/Z/08/Z]
- Medical Research Council (Prognosis Research Strategy (PROGRESS) Partnership [G0902393/99558]
- Wellcome Trust Senior Research Fellowship in Clinical Science [098504/Z/12/Z]
- National Institute for Health Research
- UCL Provost's Strategic Development Fund Fellowship
- CALIBER is funded by a Wellcome Trust [086091/Z/08/Z]
- National Institute of Health Research (NIHR) [RP-PG-0407-10314]
- UK government
- Medical Research Council (MRC)
- Farr Institute of Health Informatics Research
- Cancer Research UK (CRUK)
- Chief Scientist Office, Scottish Government Health Directorates (CSO)
- Engineering and Physical Sciences Research Council (EPSRC)
- Economic and Social Research Council (ESRC)
- National Institute for Health Research (NIHR)
- National Institute for Social Care and Health Research (NISCHR)
- Wellcome Trust
- National Institutes of Health Research (NIHR) [RP-PG-0407-10314] Funding Source: National Institutes of Health Research (NIHR)
- ESRC [ES/L007517/1] Funding Source: UKRI
- Economic and Social Research Council [ES/L007517/1] Funding Source: researchfish
- Medical Research Council [MR/K006584/1] Funding Source: researchfish
- National Institute for Health Research [RP-PG-0407-10314, NF-SI-0510-10090, PDF-2011-04-007] Funding Source: researchfish
Background Ischaemia in different arterial territories before acute myocardial infarction (AMI) may influence post-AMI outcomes. No studies have evaluated prospectively collected information on ischaemia and its effect on short- and long-term coronary mortality. The objective of this study was to compare patients with and without prospectively measured ischaemic presentations before AMI in terms of infarct characteristics and coronary mortality. Methods and results As part of the CALIBER programme, we linked data from primary care, hospital admissions, the national acute coronary syndrome registry and cause-specific mortality to identify patients with first AMI (n = 16,439). We analysed time from AMI to coronary mortality (n = 5283 deaths) using Cox regression (median 2.6 years follow-up), comparing patients with and without recent ischaemic presentations. Patients with ischaemic presentations in the 90 days before AMI experienced lower coronary mortality in the first 7 days after AMI compared with those with no prior ischaemic presentations, after adjusting for age, sex, smoking, diabetes, blood pressure and cardiovascular medications [HR: 0.64 (95% CI: 0.57-0.73) P < 0.001], but subsequent mortality was higher [HR: 1.42 (1.13-1.77) P = 0.001]. Patients with ischaemic presentations closer in time to AMI had the lowest seven day mortality (P-trend = 0.001). Conclusion In the first large prospective study of ischaemic presentations prior to AMI, we have shown that those occurring closest to AMI are associated with lower short-term coronary mortality following AMI, which could represent a natural ischaemic preconditioning effect, observed in a clinical setting. Clinicaltrials.gov identifier NCT01604486.
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