非 ST 段抬高型急性冠状动脉综合征患者易损动脉粥样硬化血栓病变的预测因子。

Predictors of complicated athero-thrombotic lesions in non-ST segment acute coronary syndrome.

机构信息

Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2013 Jun;14(6):430-7. doi: 10.2459/JCM.0b013e328356a384.

DOI:10.2459/JCM.0b013e328356a384

PMID:22772600

Abstract

AIMS

Non-ST segment elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous syndrome in terms of patho-physiological mechanisms and prognosis. We sought to investigate the clinical features associated with complicated athero-thrombotic (CAT) coronary lesions and their prognostic relevance in NSTE-ACS.

METHODS

We enrolled 701 consecutive NSTE-ACS patients without previous coronary bypass undergoing coronary angiography. The study population was divided into two groups according to the presence/absence of angiographic signs of endoluminal thrombi and/or plaque rupture, defined as CAT lesions. Multivariable analyses were used to identify predictors of CAT lesions. Their relation to composite endpoint of death, re-myocardial infarction, and re-unstable angina was investigated with the use of multivariable logistic regression.

RESULTS

Patients with CAT lesions (n = 279, 40%) had a higher incidence of the combined endpoint (11.5 vs. 4.3%; P < 0.001). On multivariable analysis male sex [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.17-2.30, P = 0.004], previous percutaneous coronary intervention (PCI) (OR 0.48, 95% CI 0.32-0.72, P < 0.001), severe angina (OR 1.72, 95% CI 1.18-2.52, P = 0.005) and anterior (i.e. V1-V4) ST segment depression (STD) were independently associated with CAT lesions (OR 1.71, 95% CI 1.14-2.57, P = 0.01). After adjustment for the Global Registry of Acute Coronary Events (GRACE) score only the presence of anterior STD emerged as an independent predictor of the clinical endpoint (OR 2.68, 95% CI 1.38-5.20, P = 0.003). The incorporation of anterior STD into the GRACE risk score showed an important trend toward improving prediction of endpoint as assessed by c-statistic (0.72 vs. 0.67; P = 0.08).

CONCLUSION

In patients with NSTE-ACS male sex, severe angina and anterior STD were associated with an increased risk of CAT lesions. Patients with anterior STD were also at increased risk of in-hospital clinical events.

摘要

目的

非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）在病理生理机制和预后方面存在异质性。本研究旨在探讨与复杂动脉粥样血栓形成（CAT）性冠状动脉病变相关的临床特征及其在 NSTE-ACS 中的预后相关性。

方法

我们连续纳入 701 例接受冠状动脉造影的无冠状动脉旁路移植术史的 NSTE-ACS 患者。根据是否存在管腔血栓和/或斑块破裂的血管内影像学表现，将研究人群分为两组，定义为 CAT 病变。采用多变量分析确定 CAT 病变的预测因素。采用多变量逻辑回归分析其与死亡、再心肌梗死和再不稳定型心绞痛复合终点的关系。

结果

有 CAT 病变（n=279，40%）的患者复合终点发生率较高（11.5% vs. 4.3%；P<0.001）。多变量分析显示，男性（比值比[OR] 1.64，95%置信区间[CI] 1.17-2.30，P=0.004）、既往经皮冠状动脉介入治疗（PCI）（OR 0.48，95%CI 0.32-0.72，P<0.001）、严重心绞痛（OR 1.72，95%CI 1.18-2.52，P=0.005）和前壁（即 V1-V4 导联）ST 段压低（OR 1.71，95%CI 1.14-2.57，P=0.01）与 CAT 病变独立相关。在校正全球急性冠状动脉事件注册（GRACE）评分后，仅前壁 ST 段压低是临床终点的独立预测因素（OR 2.68，95%CI 1.38-5.20，P=0.003）。将前壁 ST 段压低纳入 GRACE 风险评分可显著提高终点预测的 C 统计量（0.72 比 0.67；P=0.08）。