Figueras J, Peña C, Soler-Soler J
Unitat Coronària, Servei de Cardiologia, Hospital General Universitari d'Hebron, Universitat Autònoma de Barcelona, P Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Heart. 2005 Jul;91(7):889-93. doi: 10.1136/hrt.2004.043703.
To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis.
185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre.
Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated.
Non-ST segment elevation myocardial infarction (NSTEMI) was the most frequent cause of acute pulmonary oedema (61%) followed by unstable angina (UA; 21%) and ST segment elevation myocardial infarction (STEMI; 18%). In each group, mean age was > or = 70 years, but NSTEMI patients were the oldest and > or = 65% of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction (NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease (94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration (158 v 76 microg/l in the NSTEMI group, p < 0.001) and 30 day mortality (26% v 9% in the NSTEMI group and 8% in the UA group, p < 0.024). Multivariate analysis identified ejection fraction < 40% and a peak creatine kinase MB concentration > 100 microg/l as the main prognostic markers (p < 0.03).
Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA (82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.
研究急性肺水肿潜在的急性冠脉综合征的特征及其30天预后。
185例连续入住三级护理中心的急性冠脉综合征合并急性肺水肿患者。
对临床、心电图、超声心动图、酶学和血管造影特征进行前瞻性研究。
非ST段抬高型心肌梗死（NSTEMI）是急性肺水肿最常见的原因（61%），其次是不稳定型心绞痛（UA；21%）和ST段抬高型心肌梗死（STEMI；18%）。每组患者的平均年龄均≥70岁，但NSTEMI患者年龄最大，且≥65%的患者患有慢性高血压。此外，NSTEMI和UA患者年龄更大，糖尿病、既往心肌梗死、中度至重度二尖瓣反流的发生率更高，但射血分数同样降低（NSTEMI为41%；UA为39%；STEMI为39%），舒张功能障碍的发生率和多支血管病变的发生率增加（分别为94%、87%和86%）。然而，STEMI患者的肌酸激酶MB峰值浓度更高（NSTEMI组为158 μg/L，STEMI组为76 μg/L，p<0.001），30天死亡率更高（NSTEMI组为26%，UA组为9%，STEMI组为8%，p<0.024）。多变量分析确定射血分数<40%和肌酸激酶MB峰值浓度>100 μg/L为主要预后标志物（p<0.03）。
急性肺水肿主要是老年高血压合并NSTEMI或UA患者（82%）的并发症，且多支血管病变常伴有二尖瓣反流。另一方面，射血分数同样降低的STEMI患者梗死面积更大、死亡率更高，提示急性收缩功能丧失更广泛。
