Segev Amit, Strauss Bradley H, Tan Mary, Mendelsohn Aurora A, Lai Kevin, Ashton Thomas, Fitchett David, Grima Etienne, Langer Anatoly, Goodman Shaun G
The Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Am J Cardiol. 2006 Aug 15;98(4):470-3. doi: 10.1016/j.amjcard.2006.03.023. Epub 2006 Jun 19.
We evaluated the in-hospital and 1-year outcomes and predictors of admission heart failure in patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs) without previous heart failure. We analyzed 4,825 patients with NSTE-ACS without a history of congestive heart failure who were included in the multicenter Canadian ACS Registries. Patients in Killip's class II/III on admission (n = 559, 11.6%) were compared with patients in Killip's class I. Patients with heart failure on admission were older (72 [64, 79] vs 64 [54, 73] years, p < 0.0001), with higher baseline creatinine levels (96 vs 88 mmol/dl, p <0.0001), more diabetes (32.2% vs 22.8%, p < 0.0001), hypertension (58% vs 52.4%, p = 0.014), previous myocardial infarction (MI; 38.9% vs 30.3%, p < 0.0001), previous stroke (13.5% vs 7.4%, p < 0.0001), and had more ST depression on admission (27.7% vs 17.3%, p < 0.0001). In-hospital treatment was similar except for a lower rate of aspirin therapy and fewer coronary interventions. Crude event rates were significantly higher in patients with heart failure (in-hospital death 3.6% vs 1.1%, p < 0.0001; death or MI 7.9% vs 4.7%, p = 0.0011; stroke 1.1% vs 0.4%, p = 0.03). One-year event rates were also higher in patients with heart failure (death 14.6% vs 4.4%, p < 0.0001; MI 9.3% vs 6.6%, p = 0.03; death or MI 21.5% vs 10.3%, p < 0.0001). Variables independently associated with heart failure were age (odds ratio 1.57, 95% confidence interval 1.43 to 1.73), diabetes mellitus (odds ratio 1.53, 95% confidence interval 1.24 to 1.89), admission ST depression (odds ratio 1.52, 95% confidence interval 1.22 to 1.90), previous MI, and baseline creatinine. Heart failure on admission was an independent predictor of in-hospital death, death or MI, and stroke and of 1-year death and death or MI. In conclusion, in patients with NSTE-ACS, heart failure on admission is associated with increased short- and long-term rates of death and MI.
我们评估了既往无心力衰竭的非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者的院内结局、1年结局以及入院时心力衰竭的预测因素。我们分析了纳入多中心加拿大ACS注册研究的4825例无充血性心力衰竭病史的NSTE-ACS患者。将入院时处于Killip分级II/III级的患者（n = 559，11.6%）与Killip分级I级的患者进行比较。入院时患有心力衰竭的患者年龄更大（72 [64, 79]岁 vs 64 [54, 73]岁，p < 0.0001），基线肌酐水平更高（96 vs 88 mmol/dl，p <0.0001），糖尿病更多（32.2% vs 22.8%，p < 0.0001），高血压更多（58% vs 52.4%，p = 0.014），既往有心肌梗死（MI；38.9% vs 30.3%，p < 0.0001），既往有中风（13.5% vs 7.4%，p < 0.0001），且入院时ST段压低更多（27.7% vs 17.3%，p < 0.0001）。除了阿司匹林治疗率较低和冠状动脉介入治疗较少外，院内治疗相似。心力衰竭患者的粗事件发生率显著更高（院内死亡3.6% vs 1.1%，p < 0.0001；死亡或MI 7.9% vs 4.7%，p = 0.0011；中风1.1% vs 0.4%，p = 0.03）。心力衰竭患者的1年事件发生率也更高（死亡14.6% vs 4.4%，p < 0.0001；MI 9.3% vs 6.6%，p = 0.03；死亡或MI 21.5% vs 10.3%，p < 于0.0001）。与心力衰竭独立相关的变量包括年龄（比值比1.57，95%置信区间1.43至1.73）、糖尿病（比值比1.53，95%置信区间1.24至1.89）、入院时ST段压低（比值比1.52，95%置信区间1.22至1.90）、既往MI和基线肌酐。入院时心力衰竭是院内死亡、死亡或MI、中风以及1年死亡和死亡或MI的独立预测因素。总之，在NSTE-ACS患者中，入院时心力衰竭与短期和长期死亡及MI发生率增加相关。
