摘要
目的对急性冠脉综合征(ACS)患者心力衰竭(HF)的发生率、相关危险因素、治疗及对院内预后的影响进行初步分析。方法对2007年连续入选的431例ACS患者的临床资料进行回顾性分析。结果入院时合并HF的患者占26.5%。发生HF的ACS患者年龄较大,女性居多,既往心肌梗死、HF及糖尿病比例较高,多合并感染,入院时心率增快,白细胞计数和血肌酐明显升高,血红蛋白及白蛋白水平降低,cTNI峰值显著升高(P<0.05)。Logistic回归分析显示发生HF的独立危险因素为既往HF、入院合并感染、发生急性心肌梗死、CKD分期增加、入院时心率增快、高龄和低白蛋白水平。合并HF的ACS患者成功进行冠脉造影的比例显著降低,合并3支及左主干病变的比例较高(P<0.05),接受血运重建治疗较少(P=0.45),而院内再发心肌梗死、发生心律失常、再发HF的风险比为3.79～13.8,院内死亡的风险增加5.66倍,住院日中位数延长了6天(P<0.01)。结论 ACS患者入院HF的发生率较高,合并的临床疾病及危险因素更多,成功进行冠脉造影及血运重建治疗的比例较低,院内心血管不良事件的发生率增高。
Objective To determine the prevalence, risk factors, treatment patterns and in-hospital outcomes of heart failure （HF） occurring at admission in patients with acute coronmy syndromes （ACS）. Methods The clinical data of ACS patients hospitalized in Peking University First Hospital in 2007 was retrospectively analyzed. Results 26.5% had signs of HF on presentation. Patients with HF at admission were older, more often female. More had previous myocardial infarction, HF and diabetes mellitus, as well as infection. Logistic regression analysis found the independent risk factors for HF were previous HF, infection at admission, acute myocardial infarction, higher CKD grade, faster heart rate, increasing age and lower plasma albumin. Patients with HF had significanlly higher rates for three-vessel and left main lesions, but were less likely to undergo successful cardiac catheterization and reperfu- sion therapy. They were more likely to develop recurrent myocardial infarction, arrhythmias, recurrent HF in hospi- tal, and had higher mortality rate and longer in-hospital stay. Conclusions HF occurs frequently in patients with ACS at admission, and is associated with more clinical diseases and risk factors. Patients with ACS presenting with HF are at higher risk. However, they are less likely to receive anti-platelet agents and successful angiography, as well as to be treated with reperfusion therapy.
出处
《中国医刊》
CAS
2009年第4期29-32,共4页
Chinese Journal of Medicine
关键词
急性冠脉综合征
心力衰竭
治疗
预后
acute coronary syndromes
heart failure
treatment
prognosis
