Yoshii Tomohiro, Matsuzawa Yasushi, Kato So, Sato Ryosuke, Hanajima Youhei, Kikuchi Shinnosuke, Nakahashi Hidefumi, Konishi Masaaki, Akiyama Eiichi, Minamimoto Yugo, Kimura Yuichiro, Okada Kozo, Maejima Nobuhiko, Iwahashi Noriaki, Ebina Toshiaki, Hibi Kiyoshi, Kosuge Masami, Misumi Toshihiro, Tamura Kouichi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan; National Cerebral and Cardiovascular Center, 6-1 Kishibe Shinmachi, Suita, Osaka, Japan.
Division of Cardiology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan.
Int J Cardiol. 2023 Apr 1;376:11-17. doi: 10.1016/j.ijcard.2023.01.079. Epub 2023 Feb 2.
Recently, there has been increasing awareness that bleeding may lead to adverse outcomes. Endothelial dysfunction is associated with increased risk of cardiovascular and bleeding events. This study aimed to investigate the association of endothelial dysfunction with major bleeding and specific causes of death in addition to major adverse cardiovascular events in patients with acute coronary syndrome.
This single-centre retrospective observational study was conducted at a tertiary-care hospital; patients with acute coronary syndrome were included between June 2010 and November 2014 (median follow-up, 6.1 years). The reactive hyperaemia index was assessed before their discharge; reactive hyperaemia index <1.67 was defined as endothelial dysfunction. The main outcomes were the incidence of major bleeding, all-cause death, cardiovascular death, non-cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure.
Among the included 674 patients with acute coronary syndrome, 264 (39.2%) had endothelial dysfunction. Multivariable Cox-hazard analyses revealed an independent predictive value of endothelial dysfunction for major bleeding (hazard ratio 2.29, 95% confidence interval 1.17-4.48, P = 0.016) and major adverse cardiovascular events (hazard ratio 2.04, 95% confidence interval 1.43-2.89, P < 0.001). The endothelial dysfunction group patients had a 2.5-fold greater risk of cardiovascular death; however, no association was found with non-cardiovascular death.
Endothelial dysfunction assessed using reactive hyperaemia index predicted future major cardiovascular event as well as major bleeding and cardiovascular death in patients with acute coronary syndrome.
最近，人们越来越意识到出血可能会导致不良后果。内皮功能障碍与心血管事件和出血事件风险增加有关。本研究旨在调查急性冠状动脉综合征患者内皮功能障碍与大出血、特定死因以及主要不良心血管事件之间的关联。
本单中心回顾性观察性研究在一家三级医院进行；纳入2010年6月至2014年11月期间的急性冠状动脉综合征患者（中位随访时间为6.1年）。在出院前评估反应性充血指数；反应性充血指数<1.67被定义为内皮功能障碍。主要结局包括大出血发生率、全因死亡、心血管死亡、非心血管死亡、心脏骤停复苏、非致命性心肌梗死、非致命性卒中以及因心力衰竭住院。
在纳入的674例急性冠状动脉综合征患者中，264例（39.2%）存在内皮功能障碍。多变量Cox风险分析显示，内皮功能障碍对大出血（风险比2.29，95%置信区间1.17 - 4.48，P = 0.016）和主要不良心血管事件（风险比2.04，95%置信区间1.43 - 2.89，P < 0.001）具有独立预测价值。内皮功能障碍组患者心血管死亡风险高2.5倍；然而，未发现与非心血管死亡有关联。
使用反应性充血指数评估的内皮功能障碍可预测急性冠状动脉综合征患者未来的主要心血管事件、大出血和心血管死亡。
