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首页> 中文期刊> 《中国全科医学》 >贫血对置入支架的急性冠脉综合征合并心房颤动患者病情及预后的影响研究

贫血对置入支架的急性冠脉综合征合并心房颤动患者病情及预后的影响研究

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摘要

Objective To discuss the effect of anemia on the condition and prognosis of acute coronary syndrome (ACS) patients combined with atrial fibrillation (AF) who had underwent percutaneous comary interventions (PCI).Methods By retrieving electronic medical record bases,3 156 ACS patients combined with AF undergoing PCI in 12 Beijing hospitals such as Beijing Anzhen Hospital,Capital Medical University,Fuwai Hospital,Chinese Academy of Medical Sciences,Chinese PLA General Hospital,and Navy General Hospital of the Chinese People′s Liberation Army from January 1, 2010 to January 31, 2015 were enrolled to make a multi-center retrospective study.According to hemoglobin,they were divided into anemia group (n=865) and non-anemic group (n=2 291).General information including basic information,past history,laboratory tests,ultrasonography of cardiac function between two groups was collected.The score of GRACE,CRUSADE,HAS-BLED,CHADS2,CHA2DS2-VASc was conducted according to the uniform scoring criteria.A follow-up till March 20,2016 was made to record the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding events.Results The age,length of hospital stay,height,body weight,body mass index (BMI),diastolic blood pressure,white blood cell count,haematocrit,red blood cell volume distribution width,serum creatinine (SCr),blood urea nitrogen(BUN),serum uric acid (SUA),blood albumin (ALB),endogenous creatinine clearance rate (CCr),and prothrombin activity were significantly different between two groups (P<0.05).There was no significant difference in heart rate,systolic blood pressure,red blood cell count,fasting plasma glucose (FPG),serum potassium,left ventricular ejection fraction (LVEF) and international standardized ratio (INR) between two groups (P>0.05).There was significant difference in gender,smoking history,drinking history,history of hypertension,history of diabetes,history of stroke,previous history of vascular disease,incidence of cardiac insufficiency,incidence of renal insufficiency,positive rate of occult blood,history of pacemaker implantation,Killip classification,New York Heart Association (NYHA) classification,ACS type,AF type between two groups (P<0.05);there was no significant difference in the history of PCI,history of coronary heart disease,the family history of coronary heart disease,incidence of hepatic insufficiency and incidence of hyperuricemia between two groups (P>0.05).The score of GRACE,CRUSADE,HAS-BLED,CHADS2 and CHA2DS2-VASc were significantly different between two groups (P<0.05).There were significant differences in incidence of MACCEs and all-cause deaths between two groups (P<0.05).There was no significant difference in the incidences of nonfatal myocardial infarction,nonfatal stroke and target vessel revascularization between two groups (P>0.05).There was significant difference in the incidences of massive haemorrhage and minor bleeding between two groups (P<0.05).There was no significant difference in the total incidences of massive haemorrhage and minor bleeding between two groups (P>0.05).The Kaplan-Meier survival curves of MACCEs and all-cause deaths event were significantly different between two groups (P<0.05).The Kaplan-Meier survival curves of nonfatal myocardial infarction events,nonfatal stroke events,target vessel revascularization events,and bleeding events were not significantly different between two groups (P>0.05).Multivariate Cox proportional hazards regression model analysis showed that the white blood cell count,hemoglobin,red blood cell volume distribution width,FPG,ALB,LVEF,previous PCI history,stroke history,positive occult blood,and NYHA classification were the risk factors of MACCEs (P<0.05).Conclusion ACS patients combined with AF in anemic condition have a higher incidence of MACCEs and all-cause mortality.Anemia can be used as a predictive factor of the risk of MACCEs in ACS patients with AF.%目的 探讨贫血对置入支架的急性冠脉综合征(ACS)合并心房颤动(AF)患者病情及预后的影响.方法 通过检索电子病历库,选取2010-01-01至2015-01-31在首都医科大学附属北京安贞医院、中国医学科学院阜外医院、中国人民解放军总医院、中国人民解放军海军总医院等北京市12家医院置入支架的ACS合并AF患者3 156例进行多中心的回顾性研究,根据血红蛋白分为贫血组(n=865)和非贫血组(n=2 291).收集两组患者的一般资料,包括基本信息、既往史、实验室检查、心功能超声检查;根据统一的评分标准分别进行GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分;随访截止至2016-03-20,记录主要不良心脑血管事件(MACCEs)和出血事件发生情况.结果 两组年龄、住院天数、身高、体质量、体质指数(BMI)、舒张压、白细胞计数、血细胞比容、红细胞体积分布宽度、血肌酐(SCr)、血尿素(BUN)、血尿酸(SUA)、血清蛋白(ALB)、内生肌酐清除率(CCr)、凝血酶原活动度比较,差异有统计学意义(P<0.05);两组心率、收缩压、红细胞计数、空腹血糖(FPG)、血钾、左心室射血分数(LVEF)、国际标准化比值(INR)比较,差异无统计学意义(P>0.05).两组性别、吸烟史、饮酒史、高血压史、糖尿病史、卒中史、既往血管病史、心功能不全发生率、肾功能不全发生率、便隐血阳性率、起搏器植入史、Killip分级、纽约心脏病协会(NYHA)分级、ACS类型、AF类型比较,差异有统计学意义(P<0.05);两组既往经皮冠状动脉介入(PCI)史、冠心病史、冠心病家族史、肝功能不全发生率、高尿酸血症发生率比较,差异无统计学意义(P>0.05).两组GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分比较,差异均有统计学意义(P<0.05).两组MACCEs发生率、全因死亡率比较,差异有统计学意义(P<0.05);两组非致死性心肌梗死发生率、非致死性卒中发生率、靶血管重建率比较,差异无统计学意义(P>0.05).两组大出血率、小出血率比较,差异有统计学意义(P<0.05);两组大、小总出血率比较,差异无统计学意义(P>0.05).两组MACCEs、全因死亡事件的Kaplan-Meier生存曲线比较,差异有统计学意义(P<0.05);两组非致死性心肌梗死事件、非致死性卒中事件、靶血管重建事件、出血事件的Kaplan-Meier生存曲线比较,差异无统计学意义(P>0.05).多因素Cox比例风险回归模型分析结果显示,白细胞计数、血红蛋白、红细胞体积分布宽度、FPG、ALB、LVEF、既往PCI史、卒中史、便隐血阳性、NYHA分级是MACCEs发生的风险因素(P<0.05).结论 贫血的ACS合并AF患者有更高的MACCEs发生率和全因死亡率.贫血可作为置入支架的ACS合并AF患者MACCEs风险的预测因子.

著录项

  • 来源
    《中国全科医学》 |2017年第13期|1573-1581|共9页
  • 作者

    张博阳; 陈韵岱; 宋康兴; 唐熠达; 郭成军; 李运田; 马志敏; 王显; 黄党生; 王守力; 李田昌; 刘鹏飞; 王楠楠; 王宇彬; 刘如晨; 谢秀峰; 袁海凤; 唐海红; 王峰;

  • 作者单位

    510630广东省广州市,南方医科大学第三临床医学院;

    100039北京市,中国人民解放军总医院;

    100039北京市,中国人民解放军总医院;

    100037北京市,中国医学科学院阜外医院;

    100029北京市,首都医科大学附属北京安贞医院;

    100017北京市,中国人民解放军第三0五医院;

    100730北京市,首都医科大学附属北京同仁医院;

    101121北京市,北京中医药大学东直门医院;

    100853北京市,中国人民解放军总医院第一附属医院(304);

    100101北京市,中国人民解放军第306医院;

    510630广东省广州市,南方医科大学第三临床医学院;

    100048北京市,中国人民解放军海军总医院心脏中心;

    100048北京市,中国人民解放军海军总医院心脏中心;

    100048北京市,中国人民解放军海军总医院心脏中心;

    100048北京市,中国人民解放军海军总医院心脏中心;

    100048北京市,中国人民解放军海军总医院心脏中心;

    510630广东省广州市,南方医科大学第三临床医学院;

    510630广东省广州市,南方医科大学第三临床医学院;

    100048北京市,中国人民解放军海军总医院心脏中心;

    100048北京市,中国人民解放军海军总医院心脏中心;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 R541.41;
  • 关键词

    急性冠状动脉综合征; 心房颤动; 贫血; 支架; 预后;

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