规范服用双联抗血小板药物对PCI术后冠心病患者预后的影响

目的:探讨规范服用双联抗血小板药物对经皮冠状动脉介入治疗术(PCI)后冠心病患者预后的影响。方法:选取2008-2012年在安徽医科大学第一附属医院被确诊为冠心病并行PCI的患者489例进行随访,通过COX回归方法分析规范服用双联抗血小板药物对初级终点事件(全因死亡,非致死性脑卒中及非致死性心肌梗死)及次级终点事件(Ⅳ级心功能及再血管化治疗)的影响。结果:规范服药组初级终点事件的发生率低于非规范服药组(5%∶17%,P0.001),两组间差异有统计学意义;而次级终点事件规范用药组发生率低于非规范用药组,但两组间无统计学差异。COX回归分析发现规范服用双联抗血小板药物可减少冠心病患者初级终点事件的发生率(RR=0.315,95%CI:0.150~0.666,P=0.002),但对次级终点事件无预测价值。进一步分析显示规范服用抗血小板药物仅对卒中发生的减少有统计学意义(RR=0.085,95%CI:0.020~0.366,P=0.001),对全因死亡及非致死性心肌梗死的发生无预测价值。结论:规范服用双联抗血小板药物可减少初级终点事件,特别是卒中的发生。     

轻度肾功能不全对急性冠状动脉综合征患者预后生存质量的影响

目的探讨轻度肾功能不全对急性冠状动脉综合征(ACS)患者预后生存质量的影响。方法分析2010年7月至2013年7月该院确诊为ACS的50例患者的资料,按照患者肾小球滤过率估算值(e GFR)的高低分为肾功正常组(A组,n=25)和轻度肾功不全组(B组,n=25),分析研究轻度肾功不全对ACS患者出现终点事件的相关性。结果 A组患者中初级终点事件的发生率(24.0%)显著低于B组(72.0%)(P0.05);两组患者次级终点事件的发生率无统计学差异(P0.05)。COX回归分析发现,轻度肾功不全患者发生初级终点事件的相对危险度是正常者的2.135倍(95%CI 1.056~4.560,P=0.034),轻度肾功不全对全因死亡(HR 3.224,95%CI 1.209~8.145,P=0.025)和心源性死亡(HR 3.198,95%CI0.940~9.643,P=0.041)有预测价值。结论轻度肾功不全对ACS患者的预后具有重要预测价值。     

脉搏波传导速度与心脑血管事件和死亡率的队列研究

目的:研究自然人群中颈-股脉搏波传导速度(C-FPWV)与心脑血管事件和全因死亡的关系。方法:在包头医学院第二附属医院体检科连续收集556例体检者的基本资料,并对体检者进行C-FPWV测定,平均随访5年,观察其终点事件的发生率。结果:动脉硬化组的心血管事件发生率(16.1%∶6.4%)和全因病死率(7.7%∶2.4%)均高于正常组,且差异有统计学意义。在重度动脉硬化组、轻度动脉硬化组和正常组的心血管事件发生率(分别为22.7%,10.7%和6.4%)和全因病死率(分别为10.5%,5.6%和2.4%)差异有显著统计学意义(P<0.001)。经Logistic回归分析后,重度动脉硬化组发生心脑血管事件的OR为4.609(95%CI:2.288～9.285),全因死亡的OR为4.763(95%CI:1.653～13.719)。轻度动脉硬化组发生心脑血管事件的OR为1.717(95%CI:0.822～3.586),全因死亡的OR为2.320(95%CI:0.777～6.920)。分别作C-FPWV与心脑血管事件和全因死亡的ROC曲线,得到预测心脑血管事件和全因死亡的最佳临界点分别为10.85m/s和11.05m/s...     

STEMI患者外周血FGF23、Fetuin-A与临床预后的关系

目的:探讨外周血成纤维细胞生长因子23(FGF23)、胎球蛋白A(Fetuin-A)水平与ST段抬高型心肌梗死(STMEI)患者临床预后的关系。方法:回顾性研究2011-11-2016-11明确诊断STEMI的患者257例的临床资料,并进行随访。随访终点定义为全因死亡。根据患者术前外周血FGF23水平将患者分为FGF23≥10.724pg/ml组(44例)与FGF2310.724pg/ml组(213例),比较两组患者基线资料。对随访结果作cox回归分析,评价FGF23水平对各终点事件的预测价值。根据患者术前外周血Fetuin-A水平将患者分为Fetuin-A1 035.166ng/ml组(106例)与Fetuin-A≥1 035.166ng/ml组(151例),比较两组患者基线资料。对随访结果作cox回归分析,评价Fetuin-A水平对各终点事件的预测价值。结果:随访结束时共25例患者(9.73%)死亡。多因素cox回归分析发现FGF23≥10.724pg/ml是STEMI患者1年全因死亡(HR=3.400,95%CI:1.467~7.879,P=0.004)的独立危险因素,Fetuin-A≥1 035.166ng/ml是STEMI患者1年全因死亡(HR=0.323,95%CI:0.119~0.881,P=0.027)的保护性因素。结论:外周血FGF23、Fetuin-A水平与STEMI患者预后相关,术前外周血FGF23较高、Fetuin-A较低的患者1年全因死亡的风险较大。     

血浆致动脉硬化指数对早发急性冠状动脉综合征患者PCI术后预后的影响

目的评价血浆致动脉硬化指数(AIP)对早发急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后预后的影响。方法入选208例接受单纯PCI术的早发ACS患者(男性≤55岁,女性≤65岁),以AIP=0.06为切点分为致动脉硬化表型组(n=155)和非致动脉硬化表型组(n=53),比较两组患者的临床特征。PCI术后对患者进行1年的随访,比较两组患者的病死率和主要心脑血管不良事件(MACCE)的发生率。结果致动脉硬化表型组的全因死亡率、MACCE发生率明显高于非致动脉硬化表型组(分别为11.0%比1.9%,P0.05;24.5%比11.3%,P0.05)。Logistic多因素回归分析显示,AIP与早发ACS患者PCI术后1年MACCE独立相关(OR=2.139,95%CI:1.426~3.209,P0.05);多变量Cox比例风险模型分析结果显示,AIP为早发ACS患者PCI术后1年全因死亡的独立预测因子(HR=1.347,95%CI:1.137~2.879,P0.05)。结论 AIP对早发ACS患者PCI术后全因死亡和MACCE的发生具有一定的预测价值。     

残余胆固醇与老年急性冠脉综合征患者的病变严重程度及预后的关联性研究

目的：探索残余胆固醇（RC）是否可成为老年冠脉综合征（ACS）患者的危险分层及预后评估指标。 方法：本研究为前瞻性队列观察研究。连续入组2020年3月—2021年3月于解放军总医院心血管内科住院的老年ACS患者,通过电子病历系统收集患者的基线临床资料、实验室检查等资料并计算RC水平,通过冠脉造影的分析进行Gensini评分。对所有患者进行随访,随访终点为发生主要不良心血管事件（MACEs）。采用多因素Logistic回归模型分析发生MACEs的危险因素,受试者工作特征（ROC）曲线评估不同危险因素对ACS患者预后的预测价值,并采用Spearman相关性检验评估RC与冠脉病变严重程度的关联。 结果：研究最终入选老年ACS患者740例,其中1年随访期内发生MACEs者84例（11.35%）。多因素Logistic回归分析结果显示,通过校正,LDL-c（OR=0.998,95%CI：0.997-1.000,P=0.015）与RC（OR=0.135,95%CI：0.069-0.265,P<0.001）为老年ACS发生MACEs的独立危险因素。ROC曲线分析结果显示LDL-c及RC对预后评估有良好的预测价值,AUC分别为0.754（95%CI:0.719-0.786）、0.774（95%CI:0.740-0.805）,二者联合评估预后的效能优于二者单独预测0.868(95%CI:0.840-0.893)（P<0.001）。RC与Gensini评分的相关系数R2为0.49,二者呈正相关。 结论：RC与老年ACS患者的冠脉病变狭窄程度正相关,并对患者MACEs的预后评估具有较好的应用价值。     

生长分化因子15和肝细胞生长因子对老年慢性心力衰竭患者随访5年死亡事件的预测价值

目的探讨生长分化因子15(GDF-15)和肝细胞生长因子(HGF)对慢性老年心力衰竭(CHF)患者随访5年死亡事件的预测价值。方法前瞻性病例对照研究, 收集2015年8月至2017年9月在安徽医科大学第一附属医院住院的CHF患者141例, 其中射血分数保留性CHF(HFpEF)与非射血分数保留性CHF(non-HFpEF)患者59例和82例。随访60个月全因死亡终点事件, 生存组93例和死亡组48例, 对比两组患者临床基线数据, 采用多因素Logistic回归分析、受试者工作特征曲线(ROC)和ROC下面积(AUC)、Kaplan-Meier生存曲线评估GDF-15、HGF对CHF预后价值。结果多元Logistic回归分析结果显示, GDF-15、HGF、肾小球滤过率、体质指数是CHF随访60个月预后的独立危险因素;GDF-15预测心力衰竭患者60个月死亡率的AUC值为0.769(95%CI:0.685～0.854), HGF的AUC值为0.765(95%CI:0.676～0.854), 体质指数的AUC值为0.689(95%CI:0.594～0.783), 肾小球滤过率的AUC值为0...     

不同肾功能评价指标对慢性心力衰竭患者远期预后的预测价值

目的比较不同肾功能评价指标在慢性心力衰竭(CHF)患者远期生存中的预测价值。方法选取2006年1月至2014年8月于中国中医科学院广安门医院心内科住院的CHF患者546例为研究对象,随访周期为730 d,终点事件为全因死亡。根据是否发生终点事件将546例患者分为两组:非终点事件组337例(69.0%)和终点事件组169例(31.0%)。采用受试者工作曲线(ROC)评价估算的肾小球滤过率(eGFR)、血肌酐(SCr)和血尿素氮(BUN)对CHF全因死亡的预测能力;选择各指标的最佳切点值进行分组,以Kaplan-Meier生存曲线描述各组生存率;采用多因素Cox回归模型分析不同肾功能指标与远期预后的相关性。结果共纳入CHF患者546例,其中资料完整者392例,未完成随访者154例。eGFR、SCr和BUN的ROC曲线下面积分别为0.631、0.633和0.706,最佳切点值分别为58.61 ml/(min·1.73 m2)、113.75μmol/L和7.41 mmol/L。Kaplan-Meier生存曲线显示,eGFR降低组、SCr升高组和BUN升高组患者全因死亡风险更高(P0.001)。校正年龄、性别、心功能等因素后,BUN是CHF全因死亡的独立危险因素(HR=1.043,95%CI:1.007～1.082,P0.001)。结论 eGFR、SCr和BUN对CHF远期预后具有预测价值,其中BUN是CHF全因死亡的独立危险因素。     

贫血对老年患者远期缺血性动脉血栓事件及死亡住院风险的预测

目的探讨贫血对老年患者远期缺血性心血管事件及死亡住院风险的预测价值。方法收集2008年4月~2010年7月北京地区部队干休所年龄≥60岁的离退休干部及其家属663例,根据国际卫生组织WHO贫血诊断标准分为贫血组91例与非贫血组572例,随访截止至2014年12月31日,观察终点事件,包括随访期首次因急性缺血性动脉血栓性(心肌梗死、缺血性脑卒中、不稳定性心绞痛和短暂性脑缺血发作)及全因死亡住院的事件及时间。结果随访4.4~6.7(5.5±0.9)年,205例患者发生终点事件,发生率30.9%。贫血组终点事件发生率明显高于对照组(52.7%vs 27.4%,P0.01)。Kaplan-Meier生存曲线分析显示,贫血组终点事件发生率是非贫血组的2.10倍(95%CI:1.39~3.17,P0.01)。经多因素校正后,贫血组终点事件发生率是非贫血组的1.64倍(95%CI:1.15~2.35,P0.01)。结论贫血是老年患者远期因动脉血栓事件及全因死亡住院风险独立的预测因子。     

OX40L对非ST段抬高性急性冠状动脉综合征再缺血事件的预测

目的:探讨非ST段抬高性急性冠状动脉综合征(ACS)患者外周血淋巴细胞表达OX40L及血浆可溶性OX40L(sOX40L)水平与再发缺血事件的关系。方法:选取我院336例非ST段抬高性ACS住院患者,收集患者基线资料及180d内发生急性心肌梗死(AMI)及因ACS再住院情况,对患者入院时血淋巴细胞表达OX40L、血浆sOX40L水平、高敏C反应蛋白(hs-CRP)水平进行检测;分析OX40L在淋巴细胞上的表达、血浆OX40L水平与再发缺血事件的关系并与CRP及预后的关系相比较。结果:外周血淋巴细胞OX40L高表达水平者随访30d(P<0.05)、高hs-CRP水平者30d(P<0.05)再缺血事件发生率高,Kaplan-Meier生存分析显示,较高淋巴细胞OX40L表达对30d预后的预测作用与较低水平者差异有统计学意义,淋巴细胞OX40L表达较hs-CRP水平更能提示近期预后。Logistic回归分析显示:年龄(OR:2.37,95%CI 1.10～4.81,P<0.05)、血糖水平(OR:2.46,95%CI1.16～4.92,P<0.05)、淋巴细胞OX40L表达水平(OR:4.20,95%CI 2.41～7.09,P<0.05)、血清hs-CRP(3.46,95%CI 1.39～7.82,P<0.05)为随访30d内再缺血事件发生的独立预测因素。结论:ACS患者急性期淋巴细胞OX40L表达、血清sOX40L水平可预测近期再缺血事件。     

非高密度脂蛋白胆固醇与急性冠脉综合征患者早期再发主要心血管事件的关系及其临床意义

目的 分析非高密度脂蛋白胆固醇(Non-HDL-C)与急性冠脉综合征（ACS）患者早期再发主要心血管事件（MACE）的关系,探讨Non-HDL-C对ACS患者早期再发MACE的预测价值。方法 采用病例对照研究方法,收集408例ACS患者入院时临床资料,通过院内观察和院外随访记录发病30 d内再发MACE的情况,根据是否再发MACE将患者分为事件组和非事件组,比较分析两组间各指标的差异。结果 ①事件组的基线Non-HDL-C水平明显高于非事件组〔（3.6±0.7）mmol/L vs.(3.2±0.6)mmol/L,P<0.01〕。②多因素logistic回归分析显示Non-HDL-C、超敏C反应蛋白（hs-CRP）、红细胞分布宽度（RDW）、年龄是再发MACE的危险因素,高密度脂蛋白胆固醇（HDL-C）则是显著的保护因素。③ 受试者工作特征曲线(ROC曲线)显示Non-HDL-C的曲线下面积为0.672(95%CI:0.610-0.735),当截断点选定3.31 mmol/L时,其预测效率最高,灵敏度为68.3%,特异度为64.3%。结论 Non-HDL-C是ACS患者早期再发MACE的危险因素,对ACS患者早期再发MACE有一定预测价值。     

Valor pronóstico de las frecuencias cardiacas bajas en pacientes ingresados con infarto agudo de miocardio

Introduction and objectivesThe risk prediction scores adopted in acute coronary syndromes (ACS) use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, previous studies reported a nonlinear relationship between HR and events, suggesting that low HR may have an unrecognized prognostic role. We aimed to assess the prognostic impact of low HR in ACS, defined as admission HR < 50 bpm.MethodsThis study analyzed data from the AMIS Plus registry, a cohort of hospitalized patients with ACS between 1999 and 2021. The primary endpoint was in-hospital all-cause mortality, while a composite of all-cause mortality, major cardiac/cerebrovascular events was set as the secondary endpoint. A multilevel statistical method was used to assess the prognostic role of low HR in ACS.ResultsThe study included 51 001 patients. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. A nonlinear relationship between HR and in-hospital mortality was observed on restricted cubic spline analysis. An HR of 50 to 75 bpm showed lower mortality than HR < 50 bpm (OR, 0.67; 95%CI, 0.47-0.99) only after primary multivariable analysis, which was not confirmed after multiple sensitivity analyses. After propensity score matching, progressive fading of the prognostic role of HR < 50 bpm was evident.ConclusionsLow admission HR in ACS is associated with a higher crude rate of adverse events. Nonetheless, after correction for baseline differences, the prognostic role of low HR was not confirmed. Therefore, low HR probably represents a marker of underlying morbidity. These results may be clinically relevant in improving the accuracy of risk scores in ACS.     

Baseline and incident hypochloremia in chronic heart failure outpatients: Clinical correlates and prognostic role

BackgroundElectrolyte serum disorders are associated with poor outcome in chronic heart failure. The aim of this study sought to identify the main driver of incident hypochloremia in chronic HF (CHF) outpatients and to determine the prognostic value of baseline and incident hypochloremia.MethodsConsecutive CHF outpatients were enrolled and clinical, laboratoristic and echocardiographic evaluations were performed at baseline and repeated yearly in a subgroup of patients. Baseline and incident hypochloremia were evaluated. During an up to 5-year follow-up, all-cause mortality was the primary end-point for outcome.ResultsAmong 506 patients enrolled, 120 patients died during follow-up. At baseline, hypochloremia was present in 10% of patients and it was associated with mortality at univariate (HR: 3.25; 95%CI: 2.04–5.18; p<0.001) and at multivariate analysis (HR 2.14; 95%CI: 1.23–3.63; p: 0.005) after correction for well-established CHF prognostic markers. Among patients with repeated evaluations and without baseline hypochloremia, in 13% of these, incident hypochloremia occurred during follow-up and furosemide equivalent daily dose was its first determinant (HR for 1 mg/die: 1.008; 95%CI: 1.004–1.013; p<0.001) at forward stepwise logistic regression analysis. Finally, incident hypochloremia was associated with mortality at univariate (HR: 4.69; 95%CI: 2.69–8.19; p<0.001) as well as at multivariate analysis (HR: 2.97; 95%CI: 1.48–5.94; p: 0.002).ConclusionsIn CHF outpatients baseline and incident hypochloremia are independently associated with all-cause mortality, thus highlighting the prognostic role of serum chloride levels which are generally unconsidered. Future studies should evaluate if the strict monitoring and correction of hypochloremia could exert a beneficial effect on prognosis.     

Comparison of glucagons like peptide-1 receptor agonists and dipeptidyl peptide-4 inhibitors regarding cardiovascular safety and mortality in type 2 diabetes mellitus: A network meta-analysis

AimThe effects of dipeptidyl peptide-4 inhibitors (DPP-4is) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) on type 2 diabetes mellitus (T2DM) on cardiovascular events and all-cause mortality were compared.MethodsThe literature on DPP-4is and SGLT-2is treatment of T2DM was searched through Pubmed, Embase, and the web of science databases with the search deadline May 15, 2020. Network meta-analysis (NMA) was used to compare the effects of two types of inhibitors on cardiovascular events (major adverse cardiovascular events (MACE), nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular (CV) death) and all-cause mortality in T2DM patients.ResultsA total of 15 articles were screened, including 125,796 patients. Compared with DPP-4is, SGLT-2is can significantly reduce MACE [OR: 0.86 95% CI (0.78, 0.92)], CV death [OR: 0.85 95% CI (0.71, 1.01)], nonfatal MI [OR: 0.84 95%CI (0.74, 0.95)] and all-cause mortality [OR: 0.78 95% CI (0.69, 0.89)]. For nonfatal stroke, DPP-4is and SGLT-2is have no statistically significant difference [OR: 0.99 95% CI (0.91, 1.07)].ConclusionThese data indicate that SGLT-2is is more beneficial to MACE and all-cause mortality in T2DM patients than DPP-4is.     

胆固醇水平对慢性心力衰竭患者预后的影响

目的:探讨总胆固醇(TC)水平对于慢性心力衰竭(CHF)患者预后的影响。方法:入选1995年至2010年805例CHF患者,按TC水平为4个亚组:TC≤160 mg/dl、TC161～200 mg/dl、TC201～239 mg/dl及≥240 mg/dl组,探讨血脂水平、其他实验室指标及超声心动图指标与预后的相关性。终点事件为全因死亡、心源性死亡。结果:平均随访(3.11±3.32)年,共发生199例终点事件,其中全因死亡占78.4%,心源性死亡占15.6%。亚组间生存率差异有统计学意义(P=0.036),TC降低提示生存率降低。多因素回归分析表明,TC水平是CHF终点事件的独立危险因素(OR=0.75,95%CI:0.62～0.89,P=0.002)。结论:TC水平是CHF死亡的独立危险因素。     

Prior exposure to aspirin in acute coronary syndrome patients: a cardiovascular risk marker or a predictor of adverse outcome? A contemporary data of a national registry

Despite the known protective cardiovascular effect of aspirin, former studies identified its prior exposure to an acute coronary syndrome (ACS) as an independent risk factor for adverse events. However, those studies did not reflect contemporary approaches. In the current study, we determine whether patients exposed to aspirin before an ACS have a worse cardiovascular risk profile and if it predicts higher risk of recurrent cardiovascular events or mortality. A cohort of patients enrolled in a national registry of ACS was analyzed according to prior exposure to aspirin. A propensity score standardized patients according to baseline comorbidities. Multivariable COX regression analysis was performed in unmatched and matched populations for a primary endpoint (composite of all-cause mortality and/or cardiovascular rehospitalization) and two secondary endpoints (all-cause mortality and cardiovascular rehospitalization, separately) at 1-year follow-up. Among 5533 ACS patients, 1763 were previously exposed to aspirin. They were older and had more comorbidities; contemporary approaches, both coronary angiography and percutaneous coronary angioplasty were less likely to be performed. Before matching the population, prior exposure to aspirin was an independent predictor of primary composite endpoint (p = 0.002) and cardiovascular rehospitalization as the secondary endpoint (p = 0.001). There were no statistically significant differences between both groups in the multivariable model for the primary or secondary endpoints after matching. Previous exposure to aspirin identified ACS patients with worse baseline characteristics, establishing its role as a cardiovascular risk marker. However, our data do not support including aspirin pretreatment in risk stratification scores as an adverse prognostic variable.     

心型脂肪酸结合蛋白在急性冠状动脉综合征患者危险分层中的价值

目的探讨急性冠状动脉综合征(ACS)患者发病早期,外周血心型脂肪酸结合蛋白(H FABP)水平对预后的预测价值。方法筛选明确诊断ACS患者677例,测定入院首次(发病<1 2 h)外周血H-FABP水平,并随访观察1、6个月和≥1 2个月时心血管不良事件。根据H-FABP水平,分为≤120.56μg/L组(低值组)509例和>120.56μg/L组(高值组)168例,比较H FABP水平和心血管不良事件的关系。结果与低值组比较,高值组1、6个月和≥12个月心因性死亡OR值分别为5.706、2.825和1.108,非致死性心肌梗死OR值分别为5.1 74、2.572和3.361,非致死性心力衰竭OR值分别为3.105、2.723和2.672。多因素logistic回归分析显示,H-FABP是ACS患者发病1、6个月和≥12个月发生复合终点事件的独立危险因素(P<0.05,P<0.01)。结论发病早期H-FABP水平升高是ACS患者再发心血管不良事件的独立危险因素。     

Prognostic value of SPECT myocardial perfusion imaging in patients with elevated cardiac troponin I levels and atypical clinical presentation.

BACKGROUND: We determined the prognostic value of myocardial perfusion imaging (MPI) in patients with atypical clinical presentations and unexpected elevation of cardiac troponin I (cTnI) levels. METHODS AND RESULTS: In 156 consecutive patients with atypical presentations for acute coronary syndromes (ACS) and elevated cTnI levels undergoing MPI within 30 days, rates of all-cause mortality (100% follow-up; median follow-up, 611 days) and 6-month cardiac death and nonfatal myocardial infarction (96% follow-up; median follow-up, 167 days) were determined. The mean age of the patients was 68 +/- 14 years. The majority of the study cohort (96%) was at low to intermediate clinical risk for ACS (Thrombolysis in Myocardial Infarction score for unstable angina/non-ST-segment elevation myocardial infarction <5). The overall event rate was high, with 45 deaths (28.8%). There were 13 cardiac deaths/nonfatal myocardial infarctions in 6 months (8.3%). A normal MPI result was associated with a high event-free survival rate, whereas an abnormal MPI result was associated with a 3-fold and 7-fold higher risk of all-cause mortality and 6-month cardiac events, respectively. An abnormal MPI result was an independent predictor of all-cause death. CONCLUSIONS: In patients with cTnI elevation and a low to intermediate risk for ACS, a normal MPI result portends a good prognosis. Patients with abnormal MPI results have a higher 6-month cardiac event rate and a worse survival rate.     

老年急性冠状动脉综合征患者预后危险因素分析

目的 探讨急性冠状动脉综合征(ACS)患者的近期预后与影响临床预后的危险因素,为ACS患者的预后风险评估提供依据.方法 入选ACS患者156例.采用无序多分类Logistic回归分析ACS患者的基线特征因素与30 d好转、死亡、心绞痛、心力衰竭的相关性.结果 将全部变量进行多因素Logistic回归分析,显示年龄(OR=1.20,95%CI:1.07～1.34)、糖尿病(OR=19.41,95%CI:3.02～124.70)、白细胞升高(OR=11.36,95%CI:1.87～69.11)及血小板升高(OR=7.72,95%CI:1.29～46.15)是30 d死亡的独立危险因素;白细胞升高(OR=2.35,95%CI:0.89～6.17)及血脂异常(OR=6.25,95%CI:2.11～18.48)是30 d心绞痛发作的独立危险因素;年龄(OR=1.10,95%CI:1.03～1.17)、男性(OR=4.18,95%CI:0.81～21.51)、白细胞升高(OR=2.97,95%CI:1.09～8.14)及血脂异常(OR=7.69,95%CI:2.39～24.76)是30 d发生心力衰竭的独立危险因素.结论 年龄、糖尿病史、血小板升高及白细胞升高是影响ACS患者30 d死亡的独立危险因素;白细胞升高及血脂异常是影响ACS患者30 d心绞痛发作的独立危险因素;年龄、男性、白细胞升高及血脂异常是影响ACS患者30 d心力衰竭的独立危险因素.

Abstract：

Objective To explore short-term prognosis of patients with acute coronary syndrome (ACS) and prognostic risk factors, and to provide information for prognostic risk assessment. Methods A total of 156 patients with acute coronary syndrome were enrolled. The correlations of baseline characteristics with 30-day improvement, death, angina pectoris and heart failure were analyzed using unordered multivariate logistic regression. Results Logistic regression analysis showed that the independent risk factors for 30-day death included age (OR=1.20, 95%CI: 1.07-1.34), diabetes (OR=19.41, 95%CI: 3.02-124.70), leukocytosis (OR=11.36, 95%CI: 1.87-69.11) and increased platelet (OR=7.72, 95%CI: 1.29-46.15). The independent risk factors for 30-day angina pectoris included leukocytosis (OR=2.35, 95%CI: 0.89-6.17) and dyslipidemia (OR=6.25, 95%CI: 2.11-18.48). The independent risk factors for the occurrence of heart failure during 30-day post-ACS included age (OR=1.10, 95%CI: 1.03-1.17), male (OR=4.18, 95%CI: 0.81-21.51), leukocytosis (OR=2.97, 95%CI: 1.09-8.14) and dyslipidemia (OR=7.69, 95%CI: 2.39-24.76). Conclusions Age, diabetes, leukocytosis and increased platelet are independent risk factors associated with 30-day death; Leukocytosis and dyslipidemia are independent risk factors associated with 30-day angina pectoris; Age, male, leukocytosis and dyslipidemia are the independent risk factors associated with 30-day heart failure.     

急性心肌梗死合并心原性休克死亡危险因素分析

目的 探讨ST段抬高的急性心肌梗死合并心原性休克(cardiogenic shock,CS)患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄(68.5±10.3)岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%(322例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.46,95%GI:1.18～1.81)、前壁梗死(OR=2.01,95%CI:1.29～3.11)、入院基线血糖＞7.8 mmol/L(OR=2.17,95%CI:1.26～3.73)、血钠＜130 mmoL/L(OR=2.21,95%CI:1.21～4.04)、左心室射血分数(LVEF)＜40%或重度左心功能障碍(LVD)(OR=3.78,95%CI:2.28～6.27)、未紧急血运重建(OR=3.53,95%CI:1.20～10.41)和使用利尿剂(OR=1.90,95%CI:1.21～2.97)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81(95%CI:0.77～0.86)和0.80(95%CI:0.75～0.84).结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.