伴有和不伴有标准可改变危险因素的急性冠状动脉综合征患者的血管造影严重程度。
Angiographic severity in acute coronary syndrome patients with and without standard modifiable risk factors.
作者信息
Papazoglou Andreas S, Farmakis Ioannis T, Zafeiropoulos Stefanos, Moysidis Dimitrios V, Karagiannidis Efstratios, Stalikas Nikolaos, Kartas Anastasios, Stamos Konstantinos, Sofidis Georgios, Doundoulakis Ioannis, Giannopoulos Georgios, Giannakoulas George, Sianos Georgios
机构信息
Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Athens Naval Hospital, Athens, Greece.
出版信息
Front Cardiovasc Med. 2022 Jul 22;9:934946. doi: 10.3389/fcvm.2022.934946. eCollection 2022.
BACKGROUND
Routine coronary artery disease (CAD) secondary prevention strategies target standard modifiable cardiovascular risk factors (SMuRFs), which include: diabetes mellitus, dyslipidemia, hypertension, and smoking. However, a significant proportion of patients with acute coronary syndrome (ACS) present without any SMuRFs. The angiographic severity of disease in this population has not yet been investigated.
METHODS
After propensity score matching of patients without SMuRFs and patients with ≥1 SMuRFs (ratio 1:3), we used zero-inflated negative binomial regression modeling to investigate the relationship of SMuRF-less status with the angiographic severity of CAD, as measured by the SYNTAX score. Survival analysis was performed to investigate differences in all-cause mortality at 30 days and at the end of follow-up period.
RESULTS
We analyzed 534 patients presenting with ACS who underwent coronary angiography. Of them, 56 (10.5%) presented without any SMuRF. After propensity score matching, the median SYNTAX score was 13.8 (IQR 0-22.1) in 56 SMuRF-less patients and 14 (IQR 5-25) in 166 patients with ≥1 SMuRFs. SMuRF-less status was associated with increased odds of zero SYNTAX score [zero-part model: odds ratio = 2.11, 95% confidence interval (CI): 1.03-4.33], but not with decreased SYNTAX score among patients with non-zero SYNTAX score (count-part model: incidence rate ratio = 0.99, 95% CI: 0.79-1.24); the overall distribution of the SYNTAX score was similar between the two groups ( = 0.26). The 30-day risk for all-cause mortality was higher for SMuRF-less patients compared to patients with ≥1 SMuRFs [hazard ratio (HR) = 3.58, 95% CI: 1.30-9.88]; however, the all-cause mortality risk was not different between the two groups over a median 1.7-year follow-up (HR = 1.72, 95% CI: 0.83-3.57).
CONCLUSION
Among patients with ACS, the absence of SMuRFs is associated with increased odds for non-obstructive CAD and with increased short-term mortality rates.
背景
常规冠状动脉疾病（CAD）二级预防策略针对的是标准的可改变心血管危险因素（SMuRFs），其中包括：糖尿病、血脂异常、高血压和吸烟。然而，相当一部分急性冠状动脉综合征（ACS）患者就诊时没有任何SMuRFs。尚未对这一人群中疾病的血管造影严重程度进行研究。
方法
在对无SMuRFs的患者和有≥1种SMuRFs的患者进行倾向评分匹配（比例1:3）后，我们使用零膨胀负二项回归模型来研究无SMuRFs状态与CAD血管造影严重程度（通过SYNTAX评分衡量）之间的关系。进行生存分析以研究30天和随访期末全因死亡率的差异。
结果
我们分析了534例接受冠状动脉造影的ACS患者。其中，56例（10.5%）就诊时没有任何SMuRFs。倾向评分匹配后，56例无SMuRFs患者的SYNTAX评分中位数为13.8（四分位间距0 - 22.1），166例有≥1种SMuRFs的患者为14（四分位间距5 - 25）。无SMuRFs状态与SYNTAX评分为零的几率增加相关[零部分模型：优势比 = 2.11，95%置信区间（CI）：1.03 - 4.33]，但与非零SYNTAX评分患者的SYNTAX评分降低无关（计数部分模型：发病率比 = 0.99，95% CI：0.79 - 1.24）；两组之间SYNTAX评分的总体分布相似（P = 0.26）。无SMuRFs的患者30天全因死亡风险高于有≥1种SMuRFs的患者[风险比（HR） = 3.58，95% CI：1.30 - 9.88]；然而，在中位1.7年的随访期内，两组之间的全因死亡风险没有差异（HR = 1.72，95% CI：0.83 - 3.57）。
结论
在ACS患者中，无SMuRFs与非阻塞性CAD几率增加及短期死亡率增加相关。
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