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心肌梗死后1个月心绞痛的患病率及预测因素

Prevalence and predictors of angina pectoris one month after myocardial infarction.

作者信息

Spertus John A, Dawson Jill, Masoudi Frederick A, Krumholz Harlan M, Reid Kimberly J, Peterson Eric D, Rumsfeld John S

机构信息

Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA.

出版信息

Am J Cardiol. 2006 Aug 1;98(3):282-8. doi: 10.1016/j.amjcard.2006.01.099. Epub 2006 Jun 6.

Abstract

Angina pectoris (AP) is a treatable symptom that is associated with mortality and decreased quality of life. The prevalence and predictors of AP 1 month after a myocardial infarction (MI), a time when additional treatments might be offered, have not been described. We prospectively enrolled 2,094 patients with MI from 19 centers in the United States and evaluated angina symptoms 1 month after discharge with the Seattle Angina Questionnaire. Multivariable logistic regression analysis was performed to identify patient and treatment characteristics associated with 1-month AP. At 1 month, 571 patients (27.3%) had AP. Women (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.09 to 1.74), younger patients (OR 1.33 per 10-year increment, 95% CI 1.20 to 1.47), those with previous coronary artery bypass (OR 1.47, 95% CI 1.05 to 2.05), smokers (OR 1.35, 95% CI 1.09 to 1.77), and those who developed postinfarct AP during the index hospitalization (OR 1.85, 95% CI 1.20 to 2.65) were more likely to have AP at follow-up. In contrast, patients who were treated with coronary artery bypass surgery during their index admission were less likely to have AP at 1 month (OR 0.5, 95% CI 0.33 to 0.77). The strongest correlate was the frequency of AP before patients' MI. Compared with those without AP before MI, those with AP < 1 time per week (OR 1.86, 95% CI 1.45 to 2.41), weekly (OR 4.24, 95% CI 3.09 to 5.82), and daily (OR 6.12, 95% CI 3.62 to 10.3) were more likely to have AP 1 month later. In conclusion, > 1 in 4 patients reported AP 1 month after an MI.

摘要

心绞痛(AP)是一种可治疗的症状,与死亡率和生活质量下降相关。心肌梗死(MI)后1个月时AP的患病率及预测因素尚未见描述,而此时可能会提供额外的治疗。我们前瞻性纳入了来自美国19个中心的2094例MI患者,并在出院1个月后使用西雅图心绞痛问卷评估心绞痛症状。进行多变量逻辑回归分析以确定与1个月时AP相关的患者及治疗特征。1个月时,571例患者(27.3%)发生AP。女性(比值比[OR]1.37,95%置信区间[CI]1.09至1.74)、年轻患者(每增加10岁OR为1.33,95%CI 1.20至1.47)、既往有冠状动脉搭桥术者(OR 1.47,95%CI 1.05至2.05)、吸烟者(OR 1.35,95%CI 1.09至1.77)以及在本次住院期间发生梗死后AP者(OR 1.85,95%CI 1.20至2.65)在随访时更易发生AP。相比之下,在本次住院期间接受冠状动脉搭桥手术治疗的患者在1个月时发生AP的可能性较小(OR 0.5,95%CI 0.33至0.77)。最强的关联因素是患者MI前AP的发作频率。与MI前无AP者相比,MI前AP发作频率<每周1次者(OR 1.86,95%CI 1.45至2.41)、每周发作1次者(OR 4.24,95%CI 3.09至5.82)以及每天发作1次者(OR 6.12,95%CI 3.62至10.3)在1个月后更易发生AP。总之,超过四分之一的患者在MI后1个月报告有AP。

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