非ST段抬高型急性冠状动脉综合征患者入院时心力衰竭的预后意义（来自加拿大急性冠状动脉综合征注册研究）
Prognostic significance of admission heart failure in patients with non-ST-elevation acute coronary syndromes (from the Canadian Acute Coronary Syndrome Registries).
作者信息
Segev Amit, Strauss Bradley H, Tan Mary, Mendelsohn Aurora A, Lai Kevin, Ashton Thomas, Fitchett David, Grima Etienne, Langer Anatoly, Goodman Shaun G
机构信息
The Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
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。
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