Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Am Heart J. 2014 Feb;167(2):267-273.e1. doi: 10.1016/j.ahj.2013.11.005. Epub 2013 Nov 20.
Symptomatic heart failure (HF) and reduced ejection fraction (REF) are both associated with mortality, but the long-term outcomes associated with the development of HF in older non-ST-segment elevation myocardial infarction (NSTEMI) patients with preserved systolic function and REF are uncertain.
We analyzed a total of 26,291 NSTEMI patients ≥65 years discharged alive in the CRUSADE Registry who had linked Medicare data. We evaluated 30-day and 1-year risks of mortality and HF readmission in 4 cohorts of patients stratified by symptomatic HF and ejection fraction: (1) no HF-PEF, (2) no HF-REF, (3) HF-PEF, and (4) HF-REF.
A total of 14,280 NSTEMI patients (54.3%) had no HF-PEF, 3,345 (12.7%) had no HF-REF, 4,913 (18.7%) had HF-PEF, and 3,753 (14.3%) had HF-REF. Compared with no HF-PEF patients, the 30-day mortality risk was higher among patients with no HF-REF (4.9% vs 1.7%, adjusted hazard ratio 2.11, 95% CI 1.69-2.63), HF-PEF (5.9% vs 1.7%, adjusted hazard ratio 1.99, 95% CI 1.64-2.41), and highest among those with HF-REF (9.3% vs 1.7%, adjusted hazard ratio 2.70, 95% CI 2.23-3.26). Similar relationships were noted in the adjusted 1-year mortality and the risks of 30-day and 1-year HF readmission.
Symptomatic HF and REF during the index NSTEMI hospitalization are both associated with an increased risk of short- and long-term mortality as well as HF readmission with an apparent additive prognostic impact of both factors.
有症状的心衰（HF）和射血分数降低（REF）均与死亡率相关，但对于射血分数保留的老年非 ST 段抬高型心肌梗死（NSTEMI）患者中，HF 的发展与长期预后之间的关系尚不确定。
我们分析了 CRUSADE 登记处中总共 26291 名存活出院的≥65 岁的 NSTEMI 患者，并与 Medicare 数据进行了关联。我们评估了 4 个患者队列在 30 天和 1 年时的死亡率和 HF 再入院风险，这些患者队列根据有症状的 HF 和射血分数进行分层：（1）无 HF-PEF，（2）无 HF-REF，（3）HF-PEF，和（4）HF-REF。
共有 14280 名 NSTEMI 患者（54.3%）无 HF-PEF，3345 名（12.7%）无 HF-REF，4913 名（18.7%）有 HF-PEF，3753 名（14.3%）有 HF-REF。与无 HF-PEF 患者相比，无 HF-REF 患者的 30 天死亡率更高（4.9%比 1.7%，调整后的危险比 2.11，95%CI 1.69-2.63），HF-PEF 患者（5.9%比 1.7%，调整后的危险比 1.99，95%CI 1.64-2.41），HF-REF 患者的死亡率最高（9.3%比 1.7%，调整后的危险比 2.70，95%CI 2.23-3.26）。在调整后的 1 年死亡率和 30 天和 1 年 HF 再入院风险中也观察到了类似的关系。
在 NSTEMI 住院期间出现有症状的 HF 和 REF 均与短期和长期死亡率增加以及 HF 再入院风险增加相关，并且这两个因素具有明显的附加预后影响。
