Chong E, Shen L, Tan H C, Poh K K
Cardiology Department, Jurong Health, Alexandra Hospital and National University Hospital, 378 Alexandra Road, Singapore 159964.
Med J Malaysia. 2011 Aug;66(3):249-52.
Thrombolysis in Myocardial Infarction (TIMI) score has been used to predict outcomes in patients presenting with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). Our study assessed other clinical predictors for patients with UA/NSTEMI undergoing early percutaneous coronary intervention (PCI).
A cohort of 3822 patients presented with UA/NSTEMI from June 2001 to March 2008 in our center were recruited. Patients underwent PCI during admission. We analyzed the potential risk predictors for major adverse cardiac events (MACE) and death at 1 month and 6 month.
Median age was 57.1 +/- 11.1, 78.1 percent men, 34.5 percent had diabetes, 58.8 percent had hypertension. Coronary lesions involving left main and proximal left anterior descending artery was 27.6 percent. 36.1 percent had NSTEMI. Significant predictors for mortality at 6 months were age older than 70 years (p = 0.001, OR = 5.5), female gender (p = 0.001, OR = 2.98), anaemia (p < 0.001 OR = 8.47), baseline renal impairment (P < 0.001, OR = 7.38) and development of contrast nephropathy (CIN) which was defined as 25% or 0.5 mg/dl increase from baseline Creatinine within 48 h after PCI (p = 0.005, OR = 5.8). Diabetes was a predictor of MACE at 6 months (p = 0.003, OR = 1.51) but not mortality.
In patients with UA/NSTEMI, our study showed that MACE and mortality were increased in elderly, female and presence of anaemia. Mortality, but not MACE was increased in chronic renal impairment and development of CIN; while diabetes increased only MACE, but not mortality.
We analyzed a cohort of 3822 patients with UA/NSTEMI underwent PCI and found that elderly, female, presence of anemia, diabetes and chronic renal impairment were high risk predictors for adverse clinical outcome. In addition, development of CIN increased mortality.
心肌梗死溶栓（TIMI）评分已被用于预测不稳定型心绞痛（UA）和非ST段抬高型心肌梗死（NSTEMI）患者的预后。我们的研究评估了接受早期经皮冠状动脉介入治疗（PCI）的UA/NSTEMI患者的其他临床预测因素。
招募了2001年6月至2008年3月在我们中心就诊的3822例UA/NSTEMI患者。患者在入院期间接受了PCI。我们分析了1个月和6个月时主要不良心脏事件（MACE）和死亡的潜在风险预测因素。
中位年龄为57.1±11.1岁，男性占78.1%，34.5%患有糖尿病，58.8%患有高血压。累及左主干和左前降支近端的冠状动脉病变占27.6%。36.1%为NSTEMI。6个月时死亡的显著预测因素为年龄大于70岁（p = 0.001，OR = 5.5）、女性（p = 0.001，OR = 2.98）、贫血（p < 0.001，OR = 8.47）、基线肾功能损害（P < 0.001，OR = 7.38）以及造影剂肾病（CIN）的发生，CIN定义为PCI后48小时内肌酐较基线升高25%或0.5mg/dl（p = 0.005，OR = 5.8）。糖尿病是6个月时MACE的预测因素（p = 0.003，OR = 1.51），但不是死亡的预测因素。
在UA/NSTEMI患者中，我们的研究表明，老年人、女性和贫血患者的MACE和死亡率增加。慢性肾功能损害和CIN的发生会增加死亡率，但不会增加MACE；而糖尿病仅增加MACE，不增加死亡率。
我们分析了3822例接受PCI的UA/NSTEMI患者队列，发现老年人、女性、贫血、糖尿病和慢性肾功能损害是不良临床结局的高风险预测因素。此外，CIN的发生会增加死亡率。
