[入院心率对ST段抬高型心肌梗死患者短期预后的影响]

[Impact of admission heart rate on short-term outcome of ST-elevation myocardial infarction patients].

作者信息

Zhang Han, Yang Yan-min, Zhu Jun, Tan Hui-qiong, Liu Li-sheng

机构信息

Department of Emergency and Intensive Care Center, Chinese Academy of Medical Science, Beijing, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Jan;40(1):18-24.

PMID:22490628

Abstract

OBJECTIVE

To evaluate the impact of admission heart rate (HR) on 30-day all-cause death and cardiovascular events in Chinese patients with ST-elevation acute myocardial infarction (STEMI).

METHODS

A total of 7485 Chinese STEMI patients from a global randomized controlled trial (CREATE) database were divided into six groups by admission HR: < 60, 60 - 69, 70 - 79, 80 - 89, 90 - 99 and ≥ 100 bpm. The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death, reinfarction, cardiogenic shock or deadly arrhythmia.

RESULTS

Admission glucose level, proportion of female gender, incidence of anterior myocardial infarction, previous diabetes mellitus, hypertension and Killip level II-IV were significantly higher in patients with admission HR ≥ 90 bpm compared to 60 - 69 bpm group (P < 0.05). The 30-day mortality was lowest (6.3%) in the 60 - 69 bpm group and was 9.6% in HR < 60 bpm group (P < 0.05 vs. 60 - 69 bpm group). In patients with admission HR > 60 bpm, the 30-day mortality increased in proportion to higher admission HR: 8.1% in 70 - 79 bpm, 9.2% in 80 - 89 bpm, 12.6% in 90 - 99 bpm and 24.6% in ≥ 100 bpm groups (all P < 0.05 vs. 60 - 69 bpm group). The incidence of MACE was similar as that of 30-day mortality: 27.0% in < 60 bpm, 12.5% in 60 - 69 bpm, 13.7% in 70 - 79 bpm, 14.3% in 80 - 89 bpm, 17.5% in 90 - 99 bpm and 31.1% in ≥ 100 bpm groups. Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR (P < 0.05) except in the patients with admission HR < 60 bpm (OR = 0.832, P = 0.299), the risk of joint endpoint events was higher in the patients with HR < 60 bpm (OR = 1.532, 95%CI: 1.201 - 1.954, P < 0.05), 90 - 99 bpm (OR = 1.436, 95%CI: 1.091 - 1.889, P < 0.05) or ≥ 100 bpm (OR = 1.893, 95%CI: 1.471 - 2.436, P < 0.001).

CONCLUSION

Admission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.

摘要

目的

评估入院心率（HR）对中国ST段抬高型急性心肌梗死（STEMI）患者30天全因死亡及心血管事件的影响。

方法

来自一项全球随机对照试验（CREATE）数据库的7485例中国STEMI患者按入院心率分为六组：<60、60 - 69、70 - 79、80 - 89、90 - 99及≥100次/分钟。主要结局为30天全因死亡；次要结局为30天全因死亡、再梗死、心源性休克或致命性心律失常的复合结局。

结果

与60 - 69次/分钟组相比，入院心率≥90次/分钟的患者入院血糖水平、女性比例、前壁心肌梗死发生率、既往糖尿病、高血压及KillipⅡ - Ⅳ级比例显著更高（P<0.05）。60 - 69次/分钟组30天死亡率最低（6.3%），心率<6次/分钟组为9.6%（与60 - 69次/分钟组相比，P<0.05）。入院心率>次/分钟的患者中，30天死亡率随入院心率升高而增加：70 - 79次/分钟组为8.1%，80 - 89次/分钟组为9.2%，90 - 99次/分钟组为12.6%，≥100次/分钟组为24.6%（与60 - 69次/分钟组相比，均P<0.05）。主要不良心血管事件（MACE）发生率与30天死亡率相似：<60次/分钟组为27.0%，60 - 69次/分钟组为12.5%，70 - 79次/分钟组为13.7%，80 -次/分钟组为14.3%，90 - 99次/分钟组为17.5%，≥100次/分钟组为31.1%。多因素分析显示，除入院心率<60次/分钟的患者外（比值比[OR]=0.832，P=0.299），30天死亡率发生率与入院心率呈正相关（P<0.05），心率<60次/分钟（OR=1.532，95%置信区间[CI]：1.201 - 1.954，P<0.05）、90 - 99次/分钟（OR=1.436，95%CI：1.091 - 1.889，P<0.05）或≥100次/分钟（OR=1.893，95%CI：1.471 - 2.436，P<0.001）的患者联合终点事件风险更高。