摘要
目的探讨不稳定性心绞痛(UAP)患者入院后出现应激性高血压(SIH)与经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)发生率以及在院期间PCI术后并发症的关联。方法2021年1月至2024年1月连续纳入河北以岭医院接受PCI的无既往高血压病史的UAP患者875例,根据入院时的是否有一过性血压>140/90 mmHg分为SIH组(n=291)和非SIH组(n=584)。主要结局为MACE事件(包括心源性死亡、非致死性心肌梗死、再次血运重建和脑卒中)。次要结局为冠状动脉造影术后并发症(包括冠状动脉急性闭塞、假性动脉瘤、心律失常、造影剂不良反应)。采用Kaplan-Meier曲线分析生存率差异,Cox比例风险回归模型评估应激性高血压与PCI术后1年内MACE事件发生率的关联。χ^(2)检验评估SIH与在院期间PCI术后并发症发生率的关系。结果SIH组患者基线与非SIH组基线之间差异无统计学意义。Kaplan-Meier曲线显示,SIH组在12个月内的累积MACE事件发生率与非SIH组差异有统计学意义(Logrank P=0.028),Cox回归分析调整混杂因素后,发现SIH与MACE事件发生风险相关(HR=1.45,95%CI:1.01~2.09,P=0.042)。敏感性分析及亚组分析结果一致。χ^(2)检验提示SIH与在院期间PCI术后并发症无关。结论SIH是影响UAP患者PCI术后1年内MACE事件发生率的独立危险因素。
Objective To investigate the association among stress-induced hypertension(SIH)developed after admission and the incidence of major adverse cardiovascular events(MACE)following percutaneous coronary intervention(PCI),as well as postoperative complications of PCI during hospitalization,in patients with unstable angina pectoris(UAP).Methods The UAP patients(n=875)without a history of hypertension who underwent PCI were consecutively enrolled at Hebei Yiling Hospital from Jan.2021 to Jan.2024.According to the presence of transient blood pressure>140/90 mmHg on admission,the patients were divided into SIH group(n=291)and non-SIH group(n=584).The primary outcome was MACE,including cardiac death,non-fatal myocardial infarction,repeat revascularization and stroke.The secondary outcomes were postoperative complications of coronary angiography,including acute coronary occlusion,pseudoaneurysm,arrhythmia and adverse reactions to contrast medium.The difference in survival rate was analyzed by using Kaplan-Meier curve,and the association between SIH and MACE incidence was evaluated by using Cox proportional hazards regression model within 1 y after PCI.The relationship between SIH and incidence of in-hospital postoperative complications of PCI was assessed by adopted chi-square test.Results There were no significant differences in baseline characteristics between SIH group and non-SIH group.The results of Kaplan-Meier curve analysis revealed a significant difference in the cumulative incidence of MACE within 12 months between SIH group and non-SIH group(Log-rank P=0.028).After adjusting for confounding factors in Cox regression analysis,SIH was found to be associated with an increased risk of MACE(HR=1.45,95%CI:1.01-2.09,P=0.042).The results of sensitivity analysis and subgroup analysis were consistent.The results of Chi-square test indicated no association between SIH and in-hospital postoperative complications of PCI.Conclusion SIH is an dependent risk factor affecting MACE incidence within 1 y after PCI in UAP patients.
作者
张朴强
刘晓雨
刘晓玲
王红美
秘红英
ZHANG Puqiang;LIU Xiaoyu;LIU Xiaoling;WANG Hongmei;MI Hongying(Department of Cardiovascular Diseases,Hebei Yiling Hospital,Shijiazhuang 050091,China)
出处
《中国循证心血管医学杂志》
2026年第2期157-161,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北医学科学研究课题(20230733)。
