Shiraishi Yasuyuki, Kohsaka Shun, Harada Kazumasa, Miyamoto Takamichi, Tanimoto Shuzou, Iida Kiyoshi, Sakai Tetsuro, Miyazaki Tetsuro, Yagawa Mayuko, Matsushita Kenichi, Furihata Shuta, Sato Naoki, Fukuda Keiichi, Yamamoto Takeshi, Nagao Ken, Takayama Morimasa
Tokyo CCU Network Scientific Committee.
Circ J. 2016 Nov 25;80(12):2473-2481. doi: 10.1253/circj.CJ-16-0837. Epub 2016 Oct 28.
Systolic blood pressure (SBP) is an important prognostic indicator for patients with acute heart failure (AHF). However, its changes and the effects in the different phases of the acute management process are not well known.
The Tokyo CCU Network prospectively collects on-site information about AHF from emergency medical services (EMS) and the emergency room (ER). The association between in-hospital death and SBP at 2 different time points (on-site SBP [measured by EMS] and in-hospital SBP [measured at the ER; ER-SBP]) was analyzed. From 2010 to 2012, a total of 5,669 patients were registered and stratified into groups according to both their on-site SBP and ER-SBP: >160 mmHg; 100-160 mmHg; and <100 mmHg. In-hospital mortality rates increased when both on-site SBP and ER-SBP were low. After multivariate adjustment, both SBPs were inversely associated with in-hospital death. Notably, the risk for patients with ER-SBP of 100-160 mmHg (intermediate risk) differed according to their on-site SBP; those with on-site SBP <100 or 100-160 mmHg were at higher risk (OR, 7.39; 95% CI, 4.00-13.6 and OR, 2.73; 95% CI, 1.83-4.08, respectively [P<0.001 for both]) than patients with on-site SBP >160 mmHg.
Monitoring changes in SBP assisted risk stratification of AHF patients, particularly patients with intermediate ER-SBP measurements. (Circ J 2016; 80: 2473-2481).
收缩压（SBP）是急性心力衰竭（AHF）患者的一项重要预后指标。然而，其在急性处理过程不同阶段的变化及影响尚不清楚。
东京重症监护病房网络前瞻性收集来自紧急医疗服务（EMS）和急诊室（ER）的AHF现场信息。分析了两个不同时间点（现场SBP[由EMS测量]和住院期间SBP[在ER测量；ER-SBP]）的院内死亡与SBP之间的关联。2010年至2012年，共登记了5669例患者，并根据其现场SBP和ER-SBP分为几组：>160 mmHg；100 - 160 mmHg；<100 mmHg。当现场SBP和ER-SBP均较低时，院内死亡率增加。多因素调整后，两种SBP均与院内死亡呈负相关。值得注意的是，ER-SBP为100 - 160 mmHg（中度风险）的患者风险根据其现场SBP而有所不同；现场SBP<100或100 - 160 mmHg的患者比现场SBP>160 mmHg的患者风险更高（OR分别为7.39；95%CI为4.00 - 13.6和OR为2.73；95%CI为1.83 - 4.08[两者P<0.001]）。
监测SBP变化有助于AHF患者的风险分层，尤其是ER-SBP测量值为中度的患者。（《循环杂志》2016年；80：2473 - 2481）
