不同入院心率水平与ST段抬高型心肌梗死患者预后的关系

目的 探讨入院时心率水平与ST段抬高型心肌梗死(STEMI)患者近期病死率的相关性.方法分析国际大规模临床试验CREATE研究数据库中7485例中国STEMI患者,以入院不同心率水平分为＜ 60次/min组(991例)、60～69次/min组(1491例)、70～79次/min组(1743例)、80～89次/min组(1495例)、90～99次/min组(794例)和≥100次/min组(971例),分析各组患者30 d的心血管终点事件发生情况.结果基线资料显示,心率≥90次/min的2组患者中,入院血糖水平,女性、前壁梗死、既往高血压、糖尿病、心功能killipⅡ～Ⅳ级发生率均高于60～69次/min组(P＜0.05).心率＜ 60次/min组病死率高于60～69次/min组(9.6％比6.3％,P＜0.05),心率≥60次/min的所有患者中,随心率水平升高,各组间病死率呈增加趋势(依次为6.3％、8.1％、9.2％、12.6％和24.6％,P＜0.05);30 d联合终点事件发生率呈现先降低后升高的变化[心率＜60次/min 组27.0％、60～69次/min组12.5％、70～9次/min组13.7％、80～89次/min组14.3％、90～99次/min组17.5％、≥100次/min组31.1％(P＜0.001)].多因素回归分析结果显示,与心率60～69次/min组相比,＜60次/min组患者30 d病死率差异无统计学意义(p＞0.05),其余各组随心率水平升高30 d死亡风险逐步增加(心率70～79次/min组:OR=1.391,95％ CI 1.028～1.883,P＜0.05;80～89次/min组:OR=1.447,95％ CI 1.066～1.966,P＜0.05;90～99次/min组:OR=1.834,95％ CI1.303～2.582,P＜0.05;≥100次/min组:OR=2.579,95％ CI 1.893～3.515,P＜0.001);与心率60～69次/min组比较,心率＜60次/min和＞90次/min患者联合终点事件风险明显增加(OR值分别为1.532,1.436,1.893,P均＜0.05).结论STEMI患者入院心率是近期预后的危险因素.

Impact of admission heart rate on short-term outcome of ST-elevation myocardial infarction patients

Objective To evaluate the impact of admission heart rate(HR)on 30-day all-cause death and cardiovaseular events in Chinese patients with ST-elevation acute myocardial infarction(STEMI).Methods A total of 7485 Chinese STEMI patients from a global randomized controlled trial(CREATE)database were divided into six groups by admission HR: ＜60,60-69,70-79,80-89,90-99 and ≥ 100 bpm.The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death,reinfarction,cardiogenic shock or deadly arrhythmia.Results Admission glucose level,proportion of female gender,incidence of anterior myocardial infarction,previous diabetes mellitus,hypertension and Killip level Ⅱ-Ⅳ were significantly higher in patients with admission HR ≥ 90 bpm compared to 60-69 bpm group(P ＜ 0.05).The 30-day mortality was lowest(6.3％)in the 60-69 bpm group and was 9.6％ in HR ＜ 60 bpm group(P ＜0.05 vs.60-69 bpm group).In patients with admission HR ＞ 60 bpm,the 30-day mortality increased in proportion to higher admission HR: 8.1％ in 70-79 bpm,9.2％ in 80-89 bpm,12.6％ in 90-99 bpm and 24.6％ in ≥ 100 bpm groups(all P ＜0.05 vs.60-69bpm group).The incidence of MACE was similar as that of 30-day mortality: 27.0％ in ＜60 bpm,12.5％in 60-69 bpm,13.7％ in 70-79 bpm,14.3％ in 80-89bpm,17.5％ in90-99 bpm and 31.1％ in ≥100 bpm groups.Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR(P ＜0.05)except in the patients with admission HR ＜60 bpm(OR =0.832,P =0.299),the risk of joint endpoint events was higher in the patients with HR ＜60 bpm(OR =1.532,95％CI:1.201-1.954,P＜0.05),90-99bpm(OR=1.436,95％CI:1.091-1.889,P＜0.05)or ≥100bpm(OR=1.893,95％CI:1.471-2.436,P＜0.001).Conclusion Admission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.