Managed Care after Acute Myocardial Infarction (MC-AMI) – a Poland’s nationwide program of comprehensive post-MI care - improves prognosis in 12-month follow-up. Preliminary experience from a single high-volume center

医学 心肌梗塞 经皮冠状动脉介入治疗 内科学 心脏病学 射血分数 倾向得分匹配 临床终点 血运重建 康复 糖尿病 心力衰竭 物理疗法 随机对照试验 内分泌学
作者
Krystian Wita,Katarzyna Wilkosz,Marcin Wita,Andrzej Kułach,Maciej Wybraniec,Mateusz Polak,Monika Matla,Łukasz Maciejewski,Joanna Fluder,Barbara Kalańska-Łukasik,Tomasz Skowerski,Szymon Gomułka,Maciej Turski,Krzysztof Szydło
出处
期刊:International Journal of Cardiology [Elsevier BV]
卷期号:296: 8-14 被引量:12
标识
DOI:10.1016/j.ijcard.2019.06.040
摘要

Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up.In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349-0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint.MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE.
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