Takeuchi Mitsuhiro, Wada Hideki, Ogita Manabu, Takahashi Daigo, Okada-Nozaki Yui, Nishio Ryota, Yasuda Kentaro, Takahashi Norihito, Sonoda Taketo, Yatsu Shoichiro, Shitara Jun, Tsuboi Shuta, Dohi Tomotaka, Suwa Satoru, Miyauchi Katsumi, Daida Hiroyuki, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan.
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan.
Circ Rep. 2021 Apr 9;3(5):267-272. doi: 10.1253/circrep.CR-21-0010.
Cerebrovascular disease often coexists with coronary artery disease (CAD), and it has been associated with worse clinical outcomes in CAD patients. However, the prognostic effect of prior stroke on long-term outcomes in patients with acute coronary syndrome (ACS) is still unclear. An observational cohort study of ACS patients who underwent emergency percutaneous coronary intervention (PCI) between January 1999 and May 2015 was conducted. Patients were divided into 2 groups according to their history of stroke. We evaluated both all-cause death and cardiac death. Of the 2,548 consecutive ACS patients in the current cohort, 268 (10.5%) had a history of stroke at the onset of ACS. Patients with a history of stroke were older and had a higher prevalence of comorbidities such as hypertension or renal deficiency. The cumulative incidences of all-cause death and cardiac death were significantly higher in patients with a history of stroke (both log-rank P<0.0001). Multivariate Cox hazard regression analysis showed that a history of stroke was significantly associated with the incidences of all-cause death (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.20-1.85, P=0.0004) and cardiac death (HR 1.41, 95% CI 1.03-1.93, P=0.03). About 10% of the ACS patients had a history of stroke and had worse clinical outcomes.
脑血管疾病常与冠状动脉疾病（CAD）并存，且与CAD患者更差的临床结局相关。然而，既往中风对急性冠状动脉综合征（ACS）患者长期结局的预后影响仍不明确。对1999年1月至2015年5月期间接受急诊经皮冠状动脉介入治疗（PCI）的ACS患者进行了一项观察性队列研究。根据患者的中风病史将其分为两组。我们评估了全因死亡和心源性死亡情况。在本队列中连续纳入的2548例ACS患者中，268例（10.5%）在ACS发病时有中风病史。有中风病史的患者年龄更大，高血压或肾功能不全等合并症的患病率更高。有中风病史的患者全因死亡和心源性死亡的累积发生率显著更高（对数秩检验P均<0.0001）。多变量Cox风险回归分析显示，中风病史与全因死亡发生率显著相关（风险比[HR]1.49，95%置信区间[CI]1.20 - 1.85，P = 0.0004）和心源性死亡发生率（HR 1.41，95% CI 1.03 - 1.93，P = 0.03）。约10%的ACS患者有中风病史，且临床结局更差。
