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独居与非独居急性冠状动脉综合征行经皮冠状动脉介入治疗患者长期死亡率比较。

Comparison of long-term mortality between living alone patients vs. living together patients with acute coronary syndrome treated with percutaneous coronary intervention.

机构信息

Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan.

Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421, Japan.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2020 Oct 1;6(4):332-337. doi: 10.1093/ehjqcco/qcaa011.

Abstract

AIMS

Living alone is reported as an independent risk factor for cardiovascular disease. However, little is known about the association between clinical outcomes and living alone in patients with acute coronary syndrome (ACS). The aim of this study was to determine whether living alone is an independent prognostic risk factor for long-term mortality stratified by age in patients with ACS who were treated with primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS

We conducted an observational cohort study of ACS patients who underwent PCI between January 1999 and May 2015 at Juntendo University Shizuoka Hospital, Japan. The primary endpoint was all-cause death. Among 2547 ACS patients, 381 (15.0%) patients were living alone at the onset of ACS. The cumulative incidence of all-cause death was comparable between living alone and living together (34.8% vs. 34.4%, log-rank P = 0.63). However, among younger population (aged <65 years), the incidence of all-cause death was significantly higher in the living alone group (log-rank P = 0.01). Multivariate Cox hazard analysis revealed a significant association between living alone and all-cause death, even after adjusting for other risk factors (hazard ratio 2.30, 95% confidence interval 1.38-3.84, P = 0.001).

CONCLUSION

Although living alone was not significantly associated with long-term clinical outcomes in patients with ACS, it was a predictive risk factor among younger ACS patients. Careful attention should be paid to patients' lifestyle, especially younger patients with ACS.

摘要

目的

独居被报道为心血管疾病的独立危险因素。然而,对于急性冠状动脉综合征(ACS)患者的临床结局与独居之间的关系知之甚少。本研究旨在确定在接受经皮冠状动脉介入治疗(PCI)的 ACS 患者中,独居是否是与年龄分层的长期死亡率相关的独立预后危险因素。

方法和结果

我们对日本顺天堂大学静冈医院在 1999 年 1 月至 2015 年 5 月期间接受 PCI 的 ACS 患者进行了一项观察性队列研究。主要终点是全因死亡。在 2547 例 ACS 患者中,381 例(15.0%)患者在 ACS 发病时独居。独居和同住患者的全因死亡累积发生率相当(34.8% vs. 34.4%,log-rank P=0.63)。然而,在年轻人群(<65 岁)中,独居组的全因死亡率明显更高(log-rank P=0.01)。多变量 Cox 风险分析显示,独居与全因死亡之间存在显著关联,即使在调整其他危险因素后也是如此(风险比 2.30,95%置信区间 1.38-3.84,P=0.001)。

结论

尽管独居与 ACS 患者的长期临床结局无显著相关性,但它是年轻 ACS 患者的预测危险因素。应仔细关注患者的生活方式,特别是年轻的 ACS 患者。

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