Guideline adherence and long-term clinical outcomes in patients with acute myocardial infarction: a Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) substudy.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wada Hideki, Ogita Manabu, Suwa Satoru, Nakao Koichi, Ozaki Yukio, Kimura Kazuo, Ako Junya, Noguchi Teruo, Yasuda Satoshi, Fujimoto Kazuteru, Nakama Yasuharu, Morita Takashi, Shimizu Wataru, Saito Yoshihiko, Hirohata Atsushi, Morita Yasuhiro, Inoue Teruo, Okamura Atsunori, Mano Toshiaki, Hirata Kazuhito, Tanabe Kengo, Shibata Yoshisato, Owa Mafumi, Tsujita Kenichi, Funayama Hiroshi, Kokubu Nobuaki, Kozuma Ken, Uemura Shiro, Toubaru Tetsuya, Saku Keijiro, Oshima Shigeru, Nishimura Kunihiro, Miyamoto Yoshihiro, Ogawa Hisao, Ishihara Masaharu, J-MINUET investigators
Аннотация
METHODS: We investigated 3283 consecutive patients with acute myocardial infarction who were selected from a prospective, nation-wide, multicentre registry (J-MINUET) database covering 28 institutions in Japan between July 2012 and March 2014. Among the 2757 eligible patients, we evaluated the use of seven guideline-recommended therapies, including urgent revascularisation, door-to-balloon time of 90 minutes or less, and five discharge medications (P2Y12 inhibitors on aspirin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, lipid-lowering drugs). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina up to 3 years.
RESULTS: The overall median composite guideline adherence was 85.7%. Patients were divided into the following three groups: complete (100%) adherence group (n=862); moderate adherence (75% to <100%) group (n=911); and low adherence (0-75%) group (n=984). The rate of adverse cardiovascular events was significantly lower in the complete adherence group than in the low and moderate adherence groups (log rank P<0.0001). Multivariate Cox regression analysis showed complete guideline adherence was also significantly associated with lower adverse cardiovascular events compared with low guideline adherence (hazard ratio 0.66; 95% confidence interval 0.52-0.85; P=0.001).
CONCLUSION: The use of guideline-based therapies for patients with acute myocardial infarction in contemporary clinical practice was associated with significant decreases in adverse long-term clinical outcomes.
TRIAL REGISTRATION: UMIN Unique trial Number: UMIN000010037.