非ST段抬高急性冠脉综合征患者30天内发生急性心血管事件的危险因素探讨

Major risk factors of patients thirty days with non-ST elevation acute coronary syndrome

目的 分析预测非ST段抬高急性冠状动脉综合征(ACS)患者30天内发生心血管事件的独立危险因素。方法 根据283例非ST段抬高ACS患者就诊即刻的临床情况、心电图变化和心肌生化标志物水平，判断预测30天内急性心血管事件的独立危险因素；急性心血管事件的定义为死亡、恶性室性心律失常、再发心肌梗死和心绞痛、急性左心功能衰竭、需重复经皮冠状动脉成形术(PTCA)或冠状动脉旁路移植术(CABG)或再次住院。结果 共33例患者(11．7％)发生急性心血管事件；多因素分析发现30天内心血管事件的独立预测因素包括高龄(OR=1.39，95％CI 1.13～1．82，P=0．006)、糖尿病史(OR=2．21，95％CI 1．29～3．79，P=0．013)、就诊时心电图ST段压低(OR=2．49，95％CI 1．26～3．98，P=0．004)、就诊12小时内心肌生化标志物阳性(OR=2．84，95％CI 1．42～5．38，P=0．003)。结论 年龄增加、糖尿病、就诊即刻心电图ST段压低和就诊12小时以内心肌特异性酶学改变(CK-MB或TNT)4项因素是非ST段抬高ACS患者在30天内发生急性心血管事件的独立预测因素。

Objective To determine the independent factors of major adverse cardiovascular events (MACE) within 30 days of presentation in patients with non-ST elevation acute coronary syndrome (ACS). Methods This was a prospectively designed cohort study including 283 patients with unstable angina pectoris or non-ST elevations ACS.The data of presentation and the MACE were recorded within 30 days of follow-up. Death, malignant ventricular arythmia, acute heart failure, revascularization and rehospitalization were defined as MACE. Results MACE took place in 33 patients ((11.7)%). Multiple logistic regression analysis identified four presenting clinical factors predicted the 30-day MACE:① age[odds ratio(OR),(1.39); 95% confidence interval(CI), (1.13)-(1.82),P=(0.006))]; ② diabetes (OR, (2.21); 95%CI, (1.29)-(3.79),P=(0.013)); ③ baseline ST depression(OR, (2.49); 95%CI, (1.26)-(3.98),P=(0.004)); ④ myocardial enzymes positive within 12 hours of presentation (OR, (2.84); 95% CI, (1.42)-(5.38), P=(0.003)). Conclusion The prospectively designed cohort study identified age, diabetes, baseline ST depression, myocardial enzymes positive within 12 hours of presentation are the predictors of MACE within 30 day of presentation.