Incidence of heart failure and mortality after acute coronary syndromes
Incidence of heart failure and mortality after acute coronary syndromes
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DOI：
10.1016/j.ahj.2012.12.005
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发表时间：
2013-03-01
影响因子：
4.8
通讯作者：
McAlister, Finlay A.
中科院分区：
文献类型：
--
作者：
Kaul, Padma;Ezekowitz, Justin A.;McAlister, Finlay A.
背景 ST 段抬高型心肌梗死 (STEMI)、非 ST 段抬高型心肌梗死 (NSTEMI) 或不稳定型心绞痛 (UA) 患者心力衰竭 (HF) 的长期发病率尚不确定。我们检查了首次急性冠脉综合征 (ACS) 住院患者的 1 年心力衰竭发生率及其与死亡率的关系。 方法和结果 对 2002 年 4 月 1 日至 2008 年 12 月 31 日期间在加拿大艾伯塔省首次因 ACS 住院的年龄≥ 20 岁、既往无心力衰竭的患者进行了一项回顾性队列研究，并随访了 1 年。 HF 指数定义为 ACS 指数住院期间出现的并发症，出院后 HF 为 ACS 指数住院后出院后出现的 HF。 在 9,406 名 STEMI、11,008 名 NSTEMI 和 4,910 名 UA 患者中，分别有 13.6%、14.8% 和 5.2% 患有指数 HF (P < .01)。 1 年时，STEMI 患者的累积 HF 发生率为 23.4%，NSTEMI 患者为 25.4%，UA 患者为 16%。在医院幸存者中，有心衰患者的 1 年死亡率为 13.9%，出院后心衰患者的 1 年死亡率为 10.6%，无心衰患者的 1 年死亡率为 2.4%。多变量分析显示，HF指数（调整后危险比3.2，95% CI 2.7-3.7）和出院后HF（调整后危险比4.6，95% CI 3.9-5.4）均与1年死亡率相关。 结论 STEMI、NSTEMI和UA患者HF发生率存在显着差异。与指数心力衰竭和出院后心力衰竭相关的死亡风险增加表明需要对所有 ACS 患者进行警惕的随访，以便及时发现和治疗心力衰竭。 （Am Heart J 2013；165：379-385.e2。）
Background The long-term incidence of heart failure (HF) in ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) patients is uncertain. We examined the 1-year incidence of HF and its association with mortality among patients surviving their first acute coronary syndrome (ACS) hospitalization.Methods and results A retrospective cohort study of patients, aged >= 20 years, with no prior HF, hospitalized for the first time with ACS between April 1, 2002, and December 31, 2008, in Alberta, Canada, and followed up for 1 year. Index HF was defined as HF that developed as a complication during the index ACS hospitalization, and post-discharge HF, as HF developing after discharge from the index ACS hospitalization.Among 9,406 STEMI, 11,008 NSTEMI, and 4,910 UA patients, 13.6%, 14.8%, and 5.2% had index HF, respectively (P < .01). At 1-year, cumulative HF rates were 23.4% in STEMI, 25.4% in NSTEMI, and 16% in UA patients. Among hospital survivors, 1-year mortality rate was 13.9% in patients with index HF, 10.6% in patients with postdischarge HF, and 2.4% in patients with no HF. In multivariable analysis, both index HF (adjusted hazard ratio 3.2, 95% CI 2.7-3.7) and postdischarge HF (adjusted hazard ratio 4.6, 95% CI 3.9-5.4) were associated with 1-year mortality.Conclusions There are significant differences in the incidence of HF among STEMI, NSTEMI, and UA patients. The increased mortality risk associated with index HF and postdischarge HF suggests a need for vigilant follow-up of all ACS patients for prompt detection and treatment of HF. (Am Heart J 2013;165:379-385.e2.)