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Studies of survival after myocardial infarction (MI) are often based on intention to treat analyses of controlled trials.
Describe long-term survival after MI in France.
Six-year cohort study of patients recruited within 3 months after MI. Primary outcome was all-cause death. Vital status was verified in the national death registry. Analysis used Cox models with time-dependent variables and propensity scores.
Five thousand five hundred and twenty-seven (5527) subjects were included, 62.1±13 years old, 77.6% male, 9.6% smokers, 16.7% diabetic, 13.3% with previous MI. Up to 99% of patients were initially prescribed secondary prevention drugs (aspirin and/or other antiplatelet agents, beta-blockers, statins or other lipid-lowering agents, angiotensin converting enzyme inhibitors or angiotensin receptor blockers); 73% had all four classes. Overall 6-year mortality was 13.1% [95% confidence interval 12.3 to 14.0%], 2.34 per hundred patient-years (% PY); 49% returned all or all but one of the possible questionnaires (compliant [C]), 50.8% did not (non-compliant [NC]). The main predictors for death were non-compliance with study protocol (death rates NC 2.98% PY, C 1.69%PY, hazard ratio (HR) 3.13 [2.63–3.57]); increasing age at inclusion (HR up to 15.7 [10.7–23.2] for age ≥80); diabetes (1.39 [1.17–1.65]); smoking at inclusion (1.76 [1.27–2.44]), previous MI (1.46 [1.22–1.75]). Beta-blockers (0.79 [0.64–0.96]), statins (0.68 [0.51–0.90]), and enrolment in physical rehabilitation programs (0.74 [0.62–0.89]) were associated with a lower death rate.
Association of mortality with non-compliance to study protocol probably indicates general non-compliance with prevention. Analyses of treatment effects were hindered by paucity of events and of unexposed patients.Le texte complet de cet article est disponible en PDF.
Keywords : Myocardial infarction, Long-term outcomes, Cohort study, Pharmacoepidemiology, Mortality