不同入院心率水平与非ST段抬高型心肌梗死患者的预后关系研究

发布时间：2019-06-04 07:24

【摘要】：背景和目的:许多研究证实心率水平与稳定型心绞痛、急性非ST段抬高型急性冠脉综合症、急性ST段抬高型心肌梗死的预后密切相关。其中急性非ST段抬高型急性冠脉综合征中包括不稳定型心绞痛、急性非ST段抬高型心肌梗死,其中急性非ST段抬高型心肌梗死较为严重,其特点包括患者高危因素多、常累积多支血管、再发心肌梗死比例高等,长期预后差,并且国内外关于心率与非ST段抬高型心肌梗死患者预后的研究较少。本实验旨在探究入院心率水平与非ST段抬高型心肌梗死患者预后的关系,为病情的判断提供更多依据。方法:资料源于大连医科大学附属第一医院从2003年1月至2015年12月住院患的急性非ST段抬高型心肌梗死患者抬高型心肌梗死患者,累积随访1年,以死亡为随访的主要终点,次要终点为复合终点事件(包括死亡、再发心绞痛、再次心肌梗死、心力衰竭、再次血运重建治疗)。以不同入院心率水平分为分心率＜60BPM组、60～74BPM组、75～89BPM组及≥90BPM组,对随访终点事件进行统计分析,评估不同入院心率水平与非ST段抬高型心肌梗死患者预后的关系。结果:本研究纳入了 2323例患者,分为心率＜60BPM组(220例),60～74BPM组(989例),75～89BPM组(682例)、心率≥90BPM组(432例)。基线资料显示,心率≥90BPM组患者中,既往冠心病史、高血压病史、糖尿病史、脑卒中病史、Killip Ⅱ-Ⅳ级发生率、入院后血肌酐水平、空腹血糖水平、收缩压水平及LVEF＜40%的比例高于其他各组(P0.05)。单因素分析示,心率＜60BPM组死亡率高于心率60-74BPM组(5.5%比4.2%,P0.001),在心率≥60BPM各组患者中,随着心率水平的升高,各组间死亡率呈增加趋势(依次为4.2%、7.8%、14.4%,P0.001);心率＜60BPM组发生复合终点事件比例高于心率60-74BPM组(10.0%比8.4%,P0.001),在心率≥60BPM各组患者中,随着心率水平的升高,各组间发生复合终点事件比例呈增加趋势(依次为8.4%,15.1%,22.9%,P0.001)。多因素回归分析显示,在校正了各项基线资料、辅助检查及治疗情况后,入院心率水平是1年死亡和复合终点事件(包括死亡、再发心肌梗死、再发心绞痛、心力衰竭和再次血运重建治疗)的独立危险因素[分别为:(0R=1.232,95%CI 1.014-1.496,P=0.036)、(0R=1.772,95%CI 1.215-1.586,P=0.013)]。与心率60-74BPM组相比较,心率＜60BPM组1年死亡风险差异无统计学意义(P0.05),其余各组随着心率水平的升高,死亡风险随之升高(心率75～89BPM组:0R=1.892,95%CI 1.264-2.831,P=0.002;心率≥90BPM 组:0R=3.653,95%CI 2.482-5.398,P＜0.001);与心率 60-74BPM 组相比较,心率60BPM 组1年复合终点事件差异无统计学意义(P0.05),其余各组随着心率水平的升高,发生复合终点事件的风险随之升高(心率75～89BPM组:0R=1.811,95%CI 1.356-2.418,P0.001;心率≥90BPM 组:OR=2.628,95%CI 1.963-3.519,P＜0.001)。在年龄≥75岁患者中,仅当心率≥90BPM时发生死亡和复合终点事件的概率显著升高(P0.01)。亚组分析显示,采取保守治疗的患者入院心率水平仍是1年死亡和复合终点事件的独立危险因素[分别为:(OR=1.340,95%CI 1.097-1.636,P=0.004)、(0R=1.247,95%CI 1.067-1.458,P=0.006)],而采取血运重建治疗的患者这种关系不再显著(P0.05)。结论:1.入院心率水平是急性非ST段抬高型心肌梗死患者1年死亡和复合终点事件的独立危险因素。2.当心率≥60BPM时,随着入院心率水平的升高,发生死亡和复合终点事件的风险也随之升高;在年龄≥75岁的老年患者中,当心率≥90BPM时发生死亡和复合终点事件的概率显著升高。3.血运重建治疗可以改善心率对NSTEMI患者预后的不良影响。
[Abstract]:BACKGROUND & OBJECTIVE: Many studies have shown that heart rate levels are closely related to the prognosis of stable angina, acute non-ST-segment elevation acute coronary syndrome, and acute ST-segment elevation myocardial infarction. The acute non-ST-segment elevation acute coronary syndrome comprises unstable angina pectoris and acute non-ST-segment elevation type myocardial infarction, wherein the acute non-ST-segment elevation type myocardial infarction is more serious, The ratio of recurrent myocardial infarction is high and the long-term prognosis is poor, and the prognosis of patients with heart rate and non-ST elevation myocardial infarction at home and abroad is less. The purpose of this study is to explore the relationship between the heart rate level and the prognosis of non-ST-segment elevation myocardial infarction patients. Methods: The data from the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2015, the patients with acute non-ST-elevation myocardial infarction from January 2003 to December 2015 had a cumulative follow-up of 1 year to death as the primary end point of follow-up. The secondary endpoint was a composite endpoint event (including death, recurrent angina, reinfarction, heart failure, and revascularisation). The rate of heart rate was divided into 60 BPM groups,60-74 BPM group,75-89 BPM group and 90-90 BPM group, and the follow-up end-point events were statistically analyzed, and the relationship between the heart rate level and the prognosis of non-ST-segment elevation myocardial infarction patients was assessed. Results: The study included 2323 patients, including heart rate <60 BPM group (220 cases),60 ~ 74 BPM group (989 cases),75 ~ 89 BPM group (682 cases), heart rate of 90 BPM group (432 cases). The baseline data showed that the rate of prior coronary heart disease, the history of hypertension, the history of diabetes, the history of stroke, the incidence of Killip 鈪，

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