早发冠心病合并心律失常临床特点及随访研究

Clinical features of patients with premature coronary artery disease combined with arrhythmias and 2-year follow-up results

目的:研究早发冠心病合并心律失常的临床特征及两年随访结果。方法:将339例早发冠心病患者按是否合并心律失常分为心律失常组(n=85)和非心律失常组(n=254),对两组患者的临床危险因素及6、12及24个月随访结果进行分析。结果:心律失常组患者急性心肌梗死(49.4%比15.7%)、高血压病(87.1%比76.8%)、吸烟比例(42.4%比30.7%)高于非心律失常组(P<0.05),平均左室射血分数低于非心律失常组(0.55±0.10比0.63±0.09,P<0.05),病变累及左主干(8.2%比0.4%)、左回旋支(55.3%比34.6%)、右冠状动脉(70.6%比44.8%)比例高于非心律失常组(P<0.05),患者6个月(15.3%比7.9%)、12个月(22.4%比8.7%)及24个月(29.4%比12.2%)再发心绞痛、再发心肌梗死、心衰再住院、脑梗死及心源性死亡的复合终点事件发生率较非心律失常组升高(P<0.05)。结论:早发冠心病合并心律失常的患者急性心肌梗死、高血压病、吸烟史比例高于无心律失常的患者,平均左室射血分数较低,预后较差。

Objective： To study the clinical features and 2-year follow-up results in patients with premature coronary artery disease combined with arrhythmias.Methods： 339 patients with premature coronary artery disease were divided into arrhythmia group（n=85） and non-arrhythmia group（n=254）,with regard to the status of whether they were combined with arrhythmias.The clinical characteristics and 6-,12-and 24-month follow-up results in the two groups were analyzed.Results： Patients in the arrhythmia group had a higher proportion of acute myocardial infarction（49.4% vs 15.7%）,hypertension（87.1% vs 76.8%） and smoking（42.4% vs 30.7%） than the non-arrhythmia group（P0.05）.Compared with the non-arrhythmia group,the arrhythmia group had lower averaged levels of left ventricular ejection fraction（0.55±0.10 vs 0.63±0.09,P0.05）.The ratios of lesions in the left main coronary artery（8.2% vs 0.4%）,left circumflex coronary artery（55.3% vs 34.6%）,right coronary artery（70.6% vs 44.8%） were higher than that in the non-arrhythmia group（P0.05）.The incidence of composite end-point events in 6-（15.3% vs 7.9%）,12-（22.4% vs 8.7%） and 24-（29.4% vs 12.2%）month,involving recurrent angina,recurrent myocardial infarction,re-hospitalization of heart failure,cerebral infarction and cardiac death were higher in the arrhythmia group compared to the non-arrhythmia group（P0.05）.Conclusion： Compared to the non-arrhythmia group,patients with premature coronary artery disease combined with arrhythmias have higher ratios of acute myocardial infarction,hypertension,smoking,lower averaged levels of left ventricular ejection fraction and worse prognosis.