Shiraishi Yasuyuki, Kohsaka Shun, Ueda Ikuko, Inohara Taku, Sawano Mitsuaki, Numasawa Yohei, Hayashida Kentaro, Maekawa Yuichiro, Momiyama Yukihiko, Fukuda Keiichi
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Ashikaga Red Cross Hospital, Ashikaga, Japan.
Int J Clin Pract. 2016 Dec;70(12):978-987. doi: 10.1111/ijcp.12905.
Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF).
Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis).
In total, 441 (13.4%) patients had AHF upon presentation, including 76 (17.2%) with dyspnoea during moderate activity, 160 (36.3%) with dyspnoea during mild activity, and 205 (46.5%) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95% confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95% CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95% CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea.
Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.
急性冠状动脉综合征（ACS）患者几乎都要评估呼吸困难程度，但其临床意义尚未得到充分研究。我们旨在描述非ST段抬高型ACS（NSTE-ACS）合并急性心力衰竭（AHF）患者的呼吸困难严重程度与住院结局之间的关系。
2009年至2014年期间，3287例连续的NSTE-ACS患者被纳入日本前瞻性多中心PCI注册研究。合并AHF的患者根据自我报告的呼吸困难严重程度进行亚分类：无呼吸困难症状、中度活动时呼吸困难、轻度活动时呼吸困难或静息时呼吸困难。记录的结局包括住院死亡、主要心血管事件（即心源性死亡、休克、中风或大出血）和肾脏事件（即造影剂诱导的急性肾损伤[CI-AKI]或需要透析的急性肾损伤[AKI]）。
共有441例（13.4%）患者就诊时合并AHF，其中76例（17.2%）中度活动时出现呼吸困难，160例（36.3%）轻度活动时出现呼吸困难，205例（46.5%）静息时出现呼吸困难。随着呼吸困难严重程度加重，住院死亡率以及主要心血管和肾脏事件增加。多因素调整后，与无呼吸困难的患者相比，静息时呼吸困难与住院死亡率（比值比[OR]5.79；95%置信区间[CI]，2.56-13.11；P<0.001）以及主要心血管事件（OR，2.55；95%CI，1.46-4.48；P<0.001）和肾脏事件（OR，3.32；95%CI，2.05-5.38；P<0.001）密切相关。
在合并AHF的NSTE-ACS患者中，心血管和肾脏事件发生率均与呼吸困难的存在有关，且其发生率随呼吸困难严重程度平行增加。
