Ding Xiao-Jun, Zhao Yu, Li Ze-Ya, Zhang Yong-Bo, Yang An-Qi, He Yi, Huang Rong-Chong
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
J Geriatr Cardiol. 2024 Oct 28;21(10):972-980. doi: 10.26599/1671-5411.2024.10.003.
Acute coronary syndrome (ACS) presents with a variable prognosis, posing significant public health challenges. This study investigated the potential link between cerebral small vessel disease (CSVD) burden and outcomes in patients with ACS.
In this retrospective cohort study, ACS patients admitted to Beijing Friendship Hospital, Capital Medical University, Beijing, China from January 2020 to October 2021, were analyzed. CSVD burden was assessed using magnetic resonance imaging markers, including white matter lesions, lacunar infarcts, cerebral microbleeds, and enlarged perivascular spaces. The correlation between CSVD burden and clinical outcomes, including major adverse cardiovascular and cerebrovascular events, myocardial infarction (MI), target vessel revascularization, stroke, and mortality was examined over a one-year follow-up.
Out of 248 patients, 216 patients were categorized into the low score group (LSG-CSVD) and 32 patients were categorized into the high score group (HSG-CSVD). Patients in the HSG-CSVD group exhibited significantly worse prognosis, with an elevated risk of major adverse cardiovascular and cerebrovascular events, MI, and target vessel revascularization. After adjusting for age, sex, hypertension, troponin T, and estimated glomerular filtration rate, a significantly higher risk of MI was observed in the HSG-CSVD group (HR = 4.51, 95% CI: 1.53-13.26, = 0.006). Subgroup analysis by age and sex consistently demonstrated increased adverse outcomes in the HSG-CSVD.
The study highlights a direct association between increased CSVD burden and poorer ACS outcomes, particularly in MI risk. These findings underscore the importance of considering CSVD burden as a crucial prognostic factor in ACS management, facilitating risk stratification and guiding personalized treatment strategies.
急性冠状动脉综合征（ACS）的预后各异，给公共卫生带来了重大挑战。本研究调查了脑小血管疾病（CSVD）负担与ACS患者预后之间的潜在联系。
在这项回顾性队列研究中，分析了2020年1月至2021年10月在中国北京首都医科大学附属北京友谊医院住院的ACS患者。使用磁共振成像标记物评估CSVD负担，包括白质病变、腔隙性梗死、脑微出血和血管周围间隙增宽。在一年的随访中，研究了CSVD负担与临床结局之间的相关性，包括主要不良心血管和脑血管事件、心肌梗死（MI）、靶血管血运重建、中风和死亡率。
在248例患者中，216例患者被归类为低分人群（LSG-CSVD），32例患者被归类为高分人群（HSG-CSVD）。HSG-CSVD组患者的预后明显较差，主要不良心血管和脑血管事件、MI和靶血管血运重建的风险升高。在调整年龄、性别、高血压、肌钙蛋白T和估计肾小球滤过率后，HSG-CSVD组MI风险显著更高（HR = 4.51，95%CI：1.53-13.26，P = 0.006）。按年龄和性别进行的亚组分析一致显示HSG-CSVD不良结局增加。
该研究强调了CSVD负担增加与ACS较差结局之间的直接关联，尤其是在MI风险方面。这些发现强调了将CSVD负担视为ACS管理中关键预后因素的重要性，有助于风险分层并指导个性化治疗策略。
