【摘要】：背景和目的:許多研究證實(shí)心率水平與穩(wěn)定型心絞痛、急性非ST段抬高型急性冠脈綜合癥、急性ST段抬高型心肌梗死的預(yù)后密切相關(guān)。其中急性非ST段抬高型急性冠脈綜合征中包括不穩(wěn)定型心絞痛、急性非ST段抬高型心肌梗死,其中急性非ST段抬高型心肌梗死較為嚴(yán)重,其特點(diǎn)包括患者高危因素多、常累積多支血管、再發(fā)心肌梗死比例高等,長(zhǎng)期預(yù)后差,并且國(guó)內(nèi)外關(guān)于心率與非ST段抬高型心肌梗死患者預(yù)后的研究較少。本實(shí)驗(yàn)旨在探究入院心率水平與非ST段抬高型心肌梗死患者預(yù)后的關(guān)系,為病情的判斷提供更多依據(jù)。方法:資料源于大連醫(yī)科大學(xué)附屬第一醫(yī)院從2003年1月至2015年12月住院患的急性非ST段抬高型心肌梗死患者抬高型心肌梗死患者,累積隨訪1年,以死亡為隨訪的主要終點(diǎn),次要終點(diǎn)為復(fù)合終點(diǎn)事件(包括死亡、再發(fā)心絞痛、再次心肌梗死、心力衰竭、再次血運(yùn)重建治療)。以不同入院心率水平分為分心率＜60BPM組、60～74BPM組、75～89BPM組及≥90BPM組,對(duì)隨訪終點(diǎn)事件進(jìn)行統(tǒng)計(jì)分析,評(píng)估不同入院心率水平與非ST段抬高型心肌梗死患者預(yù)后的關(guān)系。結(jié)果:本研究納入了 2323例患者,分為心率＜60BPM組(220例),60～74BPM組(989例),75～89BPM組(682例)、心率≥90BPM組(432例)�；�資料顯示,心率≥90BPM組患者中,既往冠心病史、高血壓病史、糖尿病史、腦卒中病史、Killip Ⅱ-Ⅳ級(jí)發(fā)生率、入院后血肌酐水平、空腹血糖水平、收縮壓水平及LVEF＜40%的比例高于其他各組(P0.05)。單因素分析示,心率＜60BPM組死亡率高于心率60-74BPM組(5.5%比4.2%,P0.001),在心率≥60BPM各組患者中,隨著心率水平的升高,各組間死亡率呈增加趨勢(shì)(依次為4.2%、7.8%、14.4%,P0.001);心率＜60BPM組發(fā)生復(fù)合終點(diǎn)事件比例高于心率60-74BPM組(10.0%比8.4%,P0.001),在心率≥60BPM各組患者中,隨著心率水平的升高,各組間發(fā)生復(fù)合終點(diǎn)事件比例呈增加趨勢(shì)(依次為8.4%,15.1%,22.9%,P0.001)。多因素回歸分析顯示,在校正了各項(xiàng)基線資料、輔助檢查及治療情況后,入院心率水平是1年死亡和復(fù)合終點(diǎn)事件(包括死亡、再發(fā)心肌梗死、再發(fā)心絞痛、心力衰竭和再次血運(yùn)重建治療)的獨(dú)立危險(xiǎn)因素[分別為:(0R=1.232,95%CI 1.014-1.496,P=0.036)、(0R=1.772,95%CI 1.215-1.586,P=0.013)]。與心率60-74BPM組相比較,心率＜60BPM組1年死亡風(fēng)險(xiǎn)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),其余各組隨著心率水平的升高,死亡風(fēng)險(xiǎn)隨之升高(心率75～89BPM組:0R=1.892,95%CI 1.264-2.831,P=0.002;心率≥90BPM 組:0R=3.653,95%CI 2.482-5.398,P＜0.001);與心率 60-74BPM 組相比較,心率60BPM 組1年復(fù)合終點(diǎn)事件差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),其余各組隨著心率水平的升高,發(fā)生復(fù)合終點(diǎn)事件的風(fēng)險(xiǎn)隨之升高(心率75～89BPM組:0R=1.811,95%CI 1.356-2.418,P0.001;心率≥90BPM 組:OR=2.628,95%CI 1.963-3.519,P＜0.001)。在年齡≥75歲患者中,僅當(dāng)心率≥90BPM時(shí)發(fā)生死亡和復(fù)合終點(diǎn)事件的概率顯著升高(P0.01)。亞組分析顯示,采取保守治療的患者入院心率水平仍是1年死亡和復(fù)合終點(diǎn)事件的獨(dú)立危險(xiǎn)因素[分別為:(OR=1.340,95%CI 1.097-1.636,P=0.004)、(0R=1.247,95%CI 1.067-1.458,P=0.006)],而采取血運(yùn)重建治療的患者這種關(guān)系不再顯著(P0.05)。結(jié)論:1.入院心率水平是急性非ST段抬高型心肌梗死患者1年死亡和復(fù)合終點(diǎn)事件的獨(dú)立危險(xiǎn)因素。2.當(dāng)心率≥60BPM時(shí),隨著入院心率水平的升高,發(fā)生死亡和復(fù)合終點(diǎn)事件的風(fēng)險(xiǎn)也隨之升高;在年齡≥75歲的老年患者中,當(dāng)心率≥90BPM時(shí)發(fā)生死亡和復(fù)合終點(diǎn)事件的概率顯著升高。3.血運(yùn)重建治療可以改善心率對(duì)NSTEMI患者預(yù)后的不良影響。
[Abstract]:BACKGROUND & OBJECTIVE: Many studies have shown that heart rate levels are closely related to the prognosis of stable angina, acute non-ST-segment elevation acute coronary syndrome, and acute ST-segment elevation myocardial infarction. The acute non-ST-segment elevation acute coronary syndrome comprises unstable angina pectoris and acute non-ST-segment elevation type myocardial infarction, wherein the acute non-ST-segment elevation type myocardial infarction is more serious, The ratio of recurrent myocardial infarction is high and the long-term prognosis is poor, and the prognosis of patients with heart rate and non-ST elevation myocardial infarction at home and abroad is less. The purpose of this study is to explore the relationship between the heart rate level and the prognosis of non-ST-segment elevation myocardial infarction patients. Methods: The data from the First Affiliated Hospital of Dalian Medical University from January 2003 to December 2015, the patients with acute non-ST-elevation myocardial infarction from January 2003 to December 2015 had a cumulative follow-up of 1 year to death as the primary end point of follow-up. The secondary endpoint was a composite endpoint event (including death, recurrent angina, reinfarction, heart failure, and revascularisation). The rate of heart rate was divided into 60 BPM groups,60-74 BPM group,75-89 BPM group and 90-90 BPM group, and the follow-up end-point events were statistically analyzed, and the relationship between the heart rate level and the prognosis of non-ST-segment elevation myocardial infarction patients was assessed. Results: The study included 2323 patients, including heart rate <60 BPM group (220 cases),60 ~ 74 BPM group (989 cases),75 ~ 89 BPM group (682 cases), heart rate of 90 BPM group (432 cases). The baseline data showed that the rate of prior coronary heart disease, the history of hypertension, the history of diabetes, the history of stroke, the incidence of Killip 鈪，

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