日本患者急性冠状动脉综合征的临床转归：一项观察性队列研究。
Clinical outcome after acute coronary syndrome in Japanese patients: an observational cohort study.
机构信息
The Cardiovascular Institute, 7-3-10 Roppongi, Minato-ku, Tokyo 106-0032, Japan.
出版信息
J Cardiol. 2010 Jan;55(1):69-76. doi: 10.1016/j.jjcc.2009.08.007. Epub 2009 Sep 25.
BACKGROUND
Mortality and morbidity after acute coronary syndrome (ACS) in Japan appear to be different from those in Western countries due to different social healthcare systems, races, geographical locations, and interventional procedures, although data are limited in Japan.
METHODS
With a hospital-based cohort study comprising all the new patients who had visited our hospital between 2004 and 2007 (n=6562), we identified all-cause mortality, the composite endpoint of cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization and the predictors.
RESULTS
Of the total, 293 patients were included with a discharge diagnosis of ACS (median follow-up of 24.5 months). Non-ST elevation-ACS (NSTE-ACS) (unstable angina and non-ST elevation MI) and ST elevation MI (STEMI) were observed in 165 (56.3%) and 128 (43.7%) patients, respectively. Percutaneous coronary intervention or coronary artery bypass graft surgery was performed in 72.7% and 14.5% of NSTE-ACS patients, respectively and in 82.8% and 10.2% of STEMI patients. The use of aspirin, ticlopidine, and beta-blockers for NSTE-ACS patients were 93.3%, 66.9%, and 38.0%, respectively, with corresponding rates of 96.0%, 75.4%, and 57.1% for STEMI patients. All-cause mortality rates in NSTE-ACS and STEMI were 1.8% and 5.5% at 30 days, respectively, and 6.3% and 12.9% at 2 years, with corresponding rates of 3.7% and 8.7% at 30 days, respectively, and 23.4% and 35.6% at 2 years for the composite endpoint. Multivariate analysis showed that predictors for mortality were older age (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.018-1.244) and estimated glomerular filtration rate value (HR 0.96, 95% CI 0.929-0.988) in NSTE-ACS, and older age (HR 1.10, 95% CI 1.011-1.119) and congestive heart failure on admission (HR 20.0, 95% CI 2.439-164.4) in STEMI.
CONCLUSIONS
The present study identified long-term mortality, morbidity, and predictors of adverse events for Japanese patients with ACS.
背景
由于社会医疗体系、种族、地理位置和介入治疗程序不同，日本急性冠状动脉综合征（ACS）患者的死亡率和发病率与西方国家不同，尽管日本的数据有限。
方法
采用医院为基础的队列研究，纳入 2004 年至 2007 年期间我院新就诊的所有患者（n=6562），确定全因死亡率、心源性死亡、非致死性心肌梗死（MI）或靶血管血运重建的复合终点以及预测因素。
结果
共纳入 293 例出院诊断为 ACS 的患者（中位随访 24.5 个月）。非 ST 段抬高型 ACS（NSTE-ACS）（不稳定型心绞痛和非 ST 段抬高型 MI）和 ST 段抬高型心肌梗死（STEMI）分别为 165 例（56.3%）和 128 例（43.7%）。分别有 72.7%和 14.5%的 NSTE-ACS 患者接受了经皮冠状动脉介入治疗或冠状动脉旁路移植术，分别有 82.8%和 10.2%的 STEMI 患者接受了上述治疗。NSTE-ACS 患者阿司匹林、噻氯匹定和β受体阻滞剂的使用率分别为 93.3%、66.9%和 38.0%，STEMI 患者的相应使用率分别为 96.0%、75.4%和 57.1%。NSTE-ACS 和 STEMI 的 30 天全因死亡率分别为 1.8%和 5.5%，2 年死亡率分别为 6.3%和 12.9%，相应的复合终点 30 天死亡率分别为 3.7%和 8.7%，2 年死亡率分别为 23.4%和 35.6%。多变量分析显示，NSTE-ACS 患者死亡的预测因素为年龄较大（风险比[HR]1.13，95%置信区间[CI]1.018-1.244）和估计肾小球滤过率值（HR 0.96，95%CI 0.929-0.988），STEMI 患者的预测因素为年龄较大（HR 1.10，95%CI 1.011-1.119）和入院时充血性心力衰竭（HR 20.0，95%CI 2.439-164.4）。
结论
本研究确定了日本 ACS 患者的长期死亡率、发病率和不良事件预测因素。
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