内皮功能可预测急诊科胸痛单元住院患者 5 年内的不良结局。
Endothelial function predicts 5-year adverse outcome in patients hospitalized in an emergency department chest pain unit.
机构信息
Leviev Heart and Vascular Center.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
J Cardiovasc Med (Hagerstown). 2023 Oct 1;24(10):729-736. doi: 10.2459/JCM.0000000000001502. Epub 2023 May 18.
BACKGROUND
Although endothelial function is a marker for cardiovascular risk, endothelial dysfunction assessment is not routinely used in daily clinical practice. A growing challenge has emerged in identifying patients prone to cardiovascular events. We aim to investigate whether abnormal endothelial function may be associated with adverse 5-year outcomes in patients presenting to a chest pain unit (CPU).
METHODS
Following endothelial function testing using EndoPAT 2000 in 300 consecutive patients without a history of coronary artery disease, patients underwent coronary computerized tomographic angiography (CCTA) or single-photon emission computed tomography according to availability.
RESULTS
Mean 10-year Framingham risk score (FRS) was 6.6 ± 5.9%; mean 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 7.1 ± 7.2%; median reactive hyperemia index (RHI) as a measure of an endothelial function 2.0 and mean was 2.0 ± 0.4. During a 5-year follow-up, the 30 patients who developed major adverse cardiovascular events (MACE), including all-cause mortality, nonfatal myocardial infarction, hospitalization for heart failure or angina pectoris, stroke, coronary artery bypass grafting, and percutaneous coronary interventions, had higher 10-year FRS (9.6 ± 7.8 vs. 6.3 ± 5.6%; P = 0.032), higher 10-year ASCVD risk (10.4 ± 9.2 vs. 6.7 ± 6.9%; P = 0.042), lower baseline RHI (1.6 ± 0.5 vs. 2.1 ± 0.4; P < 0.001) and a greater degree of coronary atherosclerotic lesions (53 vs. 3%, P < 0.001) on CCTA compared with patients without MACE. Multivariate analysis demonstrated that RHI below the median was an independent predictor of 5-year MACE (odds ratio 5.567, 95% confidence interval 1.955-15.853; P = 0.001).
CONCLUSION
Our findings suggest that noninvasive endothelial function testing may contribute to clinical efficacy in triaging patients in the CPU and in predicting 5-year MACE.
CLINICAL TRIALSGOV IDENTIFIER
NCT01618123.
背景
尽管内皮功能是心血管风险的标志物，但内皮功能障碍的评估并未在日常临床实践中常规使用。一个日益严峻的挑战是如何识别易发生心血管事件的患者。本研究旨在探讨在因胸痛就诊的患者中，内皮功能异常是否与不良的 5 年预后相关。
方法
对 300 例无冠心病病史的连续患者使用 EndoPAT 2000 进行内皮功能检测后，根据检查条件安排行冠状动脉计算机断层扫描血管造影（CCTA）或单光子发射计算机断层扫描。
结果
平均 10 年Framingham 风险评分（FRS）为 6.6±5.9%；平均 10 年动脉粥样硬化性心血管疾病（ASCVD）风险为 7.1±7.2%；反应性充血指数（RHI）作为内皮功能的衡量指标，中位数为 2.0，平均值为 2.0±0.4。在 5 年随访期间，30 例发生主要不良心血管事件（MACE）的患者（包括全因死亡率、非致死性心肌梗死、因心力衰竭或心绞痛住院、卒中和经皮冠状动脉介入治疗），其 10 年 FRS 更高（9.6±7.8 vs. 6.3±5.6%；P=0.032），10 年 ASCVD 风险更高（10.4±9.2 vs. 6.7±6.9%；P=0.042），基线 RHI 更低（1.6±0.5 vs. 2.1±0.4；P<0.001），CCTA 显示冠状动脉粥样硬化病变程度更严重（53% vs. 3%，P<0.001）。多变量分析表明，RHI 低于中位数是 5 年 MACE 的独立预测因素（比值比 5.567，95%置信区间 1.955-15.853；P=0.001）。
结论
我们的研究结果表明，非侵入性内皮功能检测有助于对胸痛单元患者进行临床疗效分层，并预测 5 年 MACE。
临床试验.gov 标识符：NCT01618123。
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