Marcus G, Shimony S, Stein G Y, Matezky S, Iakobishvili Z, Minha S, Fuchs S
Cardiology Division, Shamir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Hematology Division, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int J Cardiol. 2020 Feb 15;301:29-33. doi: 10.1016/j.ijcard.2019.11.093. Epub 2019 Nov 9.
Among patients with stable coronary artery disease, effort-related dyspnea is associated with a larger ischemic territory and worse outcome. Whether dyspnea, not related to heart failure, is also associated with adverse outcome among patients with acute coronary syndromes (ACS) has not been fully elucidated.
We studied ACS patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) during 2010-2013 who were classified as Killip 1. A retrospective comparative analysis was performed between patients with chest pain alone (n = 2017) and those with chest pain with dyspnea (n = 417).
Patients with dyspnea were older (64.4 ± 13 vs.61.8 ± 12, p < 0.001), more frequently women (81% vs. 75% p < 0.001) and had higher rates of multiple comorbidities. Statistically significant predictors for dyspnea as a presenting symptom were female sex [HR 1.47 (1.11, 1.89)], chronic kidney disease [HR 1.81 (1.30, 2.52)], chronic obstructive pulmonary disease [HR 1.59 (1.045, 2.429)] and angina ≥24 h [HR 1.46 (1.147, 1.86)]. Patients presenting with dyspnea were less likely to undergo primary reperfusion (31% vs. 42%, p < 0.001) and overall coronary intervention (71% vs. 78%, p < 0.001) during their hospitalization. Mortality rates were significantly higher among patients presenting with dyspnea both at 30-day (3% vs. 2%, p = 0.017) and at 1-year follow-up (9% vs. 4%, p < 0.001). Dyspnea was as an independent predictor of 1-year mortality.
The presence of dyspnea is frequent and associated with adverse outcome among patients with ACS without signs of heart failure. Early identification of this higher-risk cohort of patients may allow intensifying treatment and careful follow-up may be warranted.
在稳定型冠心病患者中，劳力性呼吸困难与更大的缺血区域及更差的预后相关。对于急性冠脉综合征（ACS）患者，与心力衰竭无关的呼吸困难是否也与不良预后相关，目前尚未完全阐明。
我们研究了2010 - 2013年参加两年一次的以色列急性冠脉综合征调查（ACSIS）且被分类为Killip 1级的ACS患者。对单纯胸痛患者（n = 2017）和伴有呼吸困难的胸痛患者（n = 417）进行了回顾性比较分析。
伴有呼吸困难的患者年龄更大（64.4 ± 13岁 vs. 61.8 ± 12岁，p < 0.001），女性比例更高（81% vs. 75%，p < 0.001），且合并多种疾病的比例更高。作为首发症状的呼吸困难的统计学显著预测因素为女性[风险比（HR）1.47（1.11，1.89）]、慢性肾脏病[HR 1.81（1.30，2.52）]、慢性阻塞性肺疾病[HR 1.59（1.045，2.429）]以及心绞痛≥24小时[HR 1.46（1.147，1.86）]。伴有呼吸困难的患者在住院期间接受直接再灌注治疗的可能性较小（31% vs. 42%，p < 0.001），接受总体冠脉介入治疗的可能性也较小（71% vs. 78%，p < 0.001）。在30天（3% vs. 2%，p = 0.017）和1年随访时（9% vs. 4%，p < 0.001），伴有呼吸困难的患者死亡率显著更高。呼吸困难是1年死亡率的独立预测因素。
在无心力衰竭体征的ACS患者中，呼吸困难很常见且与不良预后相关。早期识别这一高危患者群体可能有助于加强治疗，且可能需要进行密切随访。
