伴有并发室性心律失常的自发性冠状动脉夹层的医院结局
Hospital Outcomes of Spontaneous Coronary Artery Dissection With Concurrent Ventricular Arrhythmias.
作者信息
Tan Min Choon, Yeo Yong Hao, Ang Qi Xuan, Lee Justin Z, Yang Eric H, Mazzarelli Joanne K, Pineda Jr Exequiel, Su Wilber, Lee Kwan S
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey.
出版信息
J Soc Cardiovasc Angiogr Interv. 2023 Nov 27;3(3Part A):101231. doi: 10.1016/j.jscai.2023.101231. eCollection 2024 Mar.
BACKGROUND
While patients with spontaneous coronary artery dissection (SCAD) occasionally present with concurrent ventricular arrhythmias (VA), the impact of VA on in-hospital outcomes in the United States (US) is not well-established. This study aims to analyze in-hospital outcomes of patients with SCAD and concurrent VA and to determine the factors associated with VA occurrence in this high-risk population in the US.
METHODS
Using the Nationwide Readmissions Database, our study included patients age 18 years or older who had SCAD between 2017 and 2020. We categorized the cohort into 2 groups depending on the presence of VA during hospitalization. In-hospital outcomes were assessed between SCAD patients with VA and those without. Weighted analysis was performed. We analyzed the independent factors associated with VA occurring among SCAD patients through univariable and multivariable analyses.
RESULTS
Eight hundred seventy-seven SCAD patients were included in the study: 118 (13.5%) with VA and 759 (86.6%) without. SCAD patients with concurrent VA were associated with higher rates of early mortality (10.2% vs 2.0%; < .01), prolonged index hospital stay (≥7 days) (33.1% vs 11.7%; < .01), and non-home discharge (21.2% vs 5.9%; < .01). The length of hospital stay was longer in the SCAD with concurrent VA group (7.39 days vs 3.58 days; < .01), and the median cumulative cost of hospitalization was also higher in this group ($31,451 vs $13,802; < .01). SCAD patients with concurrent VA had increased in-hospital adverse events: acute heart failure, cardiac arrest, cardiogenic shock, cerebral infarction, pulmonary edema, and acute kidney injury. In multivariable analysis, the independent factors associated with VA occurrence among SCAD patients were chronic liver disease (aOR, 3.42; 95% CI, 1.43-8.20; < .01) and heart failure (aOR, 5.63; 95% CI, 3.36-9.42; < .01).
CONCLUSIONS
Concurrence of VA among SCAD patients was associated with poorer in-hospital outcomes. Heart failure and chronic liver disease were the independent factors associated with VA occurrence in SCAD patients.
背景
虽然自发性冠状动脉夹层（SCAD）患者偶尔会并发室性心律失常（VA），但在美国，VA对住院结局的影响尚未明确。本研究旨在分析SCAD并发VA患者的住院结局，并确定美国这一高危人群中与VA发生相关的因素。
方法
利用全国再入院数据库，我们的研究纳入了2017年至2020年间年龄在18岁及以上的SCAD患者。根据住院期间是否存在VA，我们将队列分为两组。对有VA和无VA的SCAD患者的住院结局进行评估。进行加权分析。我们通过单变量和多变量分析来分析SCAD患者中与VA发生相关的独立因素。
结果
877例SCAD患者纳入研究：118例（13.5%）并发VA，759例（86.6%）未并发VA。SCAD并发VA患者的早期死亡率（10.2%对2.0%；P<0.01）、指数住院时间延长（≥7天）（33.1%对11.7%；P<0.01）和非家庭出院率（21.2%对5.9%；P<0.01）更高。SCAD并发VA组的住院时间更长（7.39天对3.58天；P<0.01），该组的住院累计费用中位数也更高（31451美元对13802美元；P<0.01）。SCAD并发VA患者的住院不良事件增加：急性心力衰竭、心脏骤停、心源性休克、脑梗死、肺水肿和急性肾损伤。在多变量分析中，SCAD患者中与VA发生相关的独立因素是慢性肝病（校正比值比[aOR]，3.42；95%置信区间[CI]，1.43 - 8.20；P<0.01）和心力衰竭（aOR，5.63；95%CI，3.36 - 9.42；P<0.01）。
结论
SCAD患者并发VA与较差的住院结局相关。心力衰竭和慢性肝病是SCAD患者中与VA发生相关的独立因素。
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