Shibata Yusaku, Kobayashi Nobuaki, Shirakabe Akihiro, Miyauchi Yasushi, Asai Kuniya
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Int J Angiol. 2023 Apr 12;32(3):179-187. doi: 10.1055/s-0043-1767697. eCollection 2023 Sep.
We aimed to examine the relationship of living arrangements (i.e., living alone or living with others) with background, clinical severity, preintervention culprit lesion plaque morphology, and clinical outcomes in patients with acute coronary syndrome (ACS). Among 1,683 consecutive patients with ACS, we retrospectively compared patients living alone ( = 318) versus living with others ( = 1,362). Optical coherence tomography (OCT) findings, which are high-resolution intracoronary imaging devices, were analyzed in patients with preintervention OCT and compared between patients living alone ( = 174) versus those living with others ( = 665). Older (median; 69 vs. 67 y, = 0.046) and female (31 vs. 17%, < 0.001) patients more frequently lived alone. Frequency of achieving a time interval of 6 hours or less from ACS onset to admission was lower in patients living alone (56 vs. 63%, = 0.022). Clinical presentation was more severe in patients living alone (Killip II/III/IV; 27 vs. 22%, = 0.029). Plaque morphology evaluated by OCT was similar between groups (plaque rapture; 48 vs. 48%, = 0.171). Kaplan-Meier analyses revealed higher rates of cardiac mortality during 2-year follow-up period in patients living alone [13.9 vs. 8.5%, hazard ratio (HR) 1.604, 95% confidence interval (CI) 1.112-2.313, = 0.010]. After traditional cardiovascular risk factors and clinical severity upon admission had been adjusted, living alone was an independent predictor of cardiac mortality in ACS patients (HR 1.582, 95% CI 1.056-2.371, = 0.026). Living alone was independently associated with 2-year cardiacmortality in ACS patients after adjusting for background and presentation and might be unrelated to the development of atherosclerosis.
我们旨在研究生活安排（即独居或与他人同住）与急性冠状动脉综合征（ACS）患者的背景、临床严重程度、干预前罪犯病变斑块形态及临床结局之间的关系。在1683例连续的ACS患者中，我们回顾性比较了独居患者（n = 318）与与他人同住的患者（n = 1362）。对有干预前光学相干断层扫描（OCT）（一种高分辨率冠状动脉内成像设备）检查结果的患者进行分析，并比较独居患者（n = 174）与与他人同住患者（n = 665）之间的情况。年龄较大（中位数：69岁对67岁，P = 0.046）和女性患者（31%对17%，P < 0.001）更常独居。独居患者从ACS发作到入院的时间间隔在6小时及以内的频率较低（56%对63%，P = 0.022）。独居患者的临床表现更严重（Killip II/III/IV级；27%对22%，P = 0.029）。通过OCT评估的斑块形态在两组之间相似（斑块破裂；48%对48%，P = 0.171）。Kaplan-Meier分析显示，在2年随访期内，独居患者的心脏死亡率较高[13.9%对8.5%，风险比（HR）1.604，95%置信区间（CI）1.112 - 2.313，P = 0.010]。在调整了传统心血管危险因素和入院时的临床严重程度后，独居是ACS患者心脏死亡的独立预测因素（HR 1.582，95% CI 1.056 - 2.371，P = 0.026）。在调整背景和临床表现后，独居与ACS患者2年心脏死亡率独立相关，且可能与动脉粥样硬化的发展无关。
