不同入院心率水平与ST段抬高型心肌梗死患者预后的关系被引量：26

Impact of admission heart rate on short-term outcome of ST-elevation myocardial infarction patients

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摘要目的探讨入院时心率水平与ST段抬高型心肌梗死（STEMI）患者近期病死率的相关性.方法分析国际大规模临床试验CREATE研究数据库中7485例中国STEMI患者,以入院不同心率水平分为＜ 60次/min组（991例）、60～69次/min组（1491例）、70～79次/min组（1743例）、80～89次/min组（1495例）、90～99次/min组（794例）和≥100次/min组（971例）,分析各组患者30 d的心血管终点事件发生情况.结果基线资料显示,心率≥90次/min的2组患者中,入院血糖水平,女性、前壁梗死、既往高血压、糖尿病、心功能killipⅡ～Ⅳ级发生率均高于60～69次/min组（P＜0.05）.心率＜ 60次/min组病死率高于60～69次/min组（9.6％比6.3％,P＜0.05）,心率≥60次/min的所有患者中,随心率水平升高,各组间病死率呈增加趋势（依次为6.3％、8.1％、9.2％、12.6％和24.6％,P＜0.05）；30 d联合终点事件发生率呈现先降低后升高的变化[心率＜60次/min 组27.0％、60～69次/min组12.5％、70～9次/min组13.7％、80～89次/min组14.3％、90～99次/min组17.5％、≥100次/min组31.1％（P＜0.001）].多因素回归分析结果显示,与心率60～69次/min组相比,＜60次/min组患者30 d病死率差异无统计学意义（p＞0.05）,其余各组随心率水平升高30 d死亡风险逐步增加（心率70～79次/min组：OR=1.391,95％ CI 1.028～1.883,P＜0.05;80～89次/min组：OR=1.447,95％ CI 1.066～1.966,P＜0.05；90～99次/min组：OR=1.834,95％ CI1.303～2.582,P＜0.05；≥100次/min组：OR=2.579,95％ CI 1.893～3.515,P＜0.001）;与心率60～69次/min组比较,心率＜60次/min和＞90次/min患者联合终点事件风险明显增加（OR值分别为1.532,1.436,1.893,P均＜0.05）.结论STEMI患者入院心率是近期预后的危险因素. Objective To evaluate the impact of admission heart rate（HR）on 30-day all-cause death and cardiovaseular events in Chinese patients with ST-elevation acute myocardial infarction（STEMI）.Methods A total of 7485 Chinese STEMI patients from a global randomized controlled trial（CREATE）database were divided into six groups by admission HR：〈60,60-69,70-79,80-89,90-99 and ≥ 100 bpm.The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death,reinfarction,cardiogenic shock or deadly arrhythmia.Results Admission glucose level,proportion of female gender,incidence of anterior myocardial infarction,previous diabetes mellitus,hypertension and Killip level Ⅱ-Ⅳ were significantly higher in patients with admission HR ≥ 90 bpm compared to 60-69 bpm group（P 〈 0.05）.The 30-day mortality was lowest（6.3%）in the 60-69 bpm group and was 9.6% in HR 〈 60 bpm group（P 〈0.05 vs.60-69 bpm group）.In patients with admission HR 〉 60 bpm,the 30-day mortality increased in proportion to higher admission HR： 8.1% in 70-79 bpm,9.2% in 80-89 bpm,12.6% in 90-99 bpm and 24.6% in ≥ 100 bpm groups（all P 〈0.05 vs.60-69bpm group）.The incidence of MACE was similar as that of 30-day mortality： 27.0% in 〈60 bpm,12.5%in 60-69 bpm,13.7% in 70-79 bpm,14.3% in 80-89bpm,17.5% in90-99 bpm and 31.1% in ≥100 bpm groups.Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR（P 〈0.05）except in the patients with admission HR 〈60 bpm（OR =0.832,P =0.299）,the risk of joint endpoint events was higher in the patients with HR 〈60 bpm（OR =1.532,95%CI：1.201-1.954,P〈0.05）,90-99bpm（OR=1.436,95%CI：1.091-1.889,P〈0.05）or ≥100bpm（OR=1.893,95%CI：1.471-2.436,P〈0.001）.Conclusion Admission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.

作者张晗杨艳敏朱俊谭慧琼刘力生

机构地区北京协和医学院中国医学科学院阜外心血管病医院急重症中心北京协和医学院中国医学科学院高血压诊治中心

出处《中华心血管病杂志》 CAS CSCD 北大核心 2012年第1期18-24,共7页 Chinese Journal of Cardiology

关键词心肌梗死心率预后死亡率 Myocardial infarction Heart rate Outcome Mortality

分类号 R542.22 [医药卫生—心血管疾病]

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