反应性充血指数预测非阻塞性急性冠脉综合征患者的中远期预后

Reactive hyperemia index predicts mid-long-term prognosis of non-obstructive acute coronary syndrome

目的探讨反应性充血指数(reactive hyperemia index,RHI)与非阻塞性急性冠脉综合征(non-obstructive acute coronary syndrome,Nob ACS)患者中远期心脏不良事件(cardiac adverse events,AEs)的关系。方法本研究为前瞻性队列研究,连续收集陆军军医大学第二附属医院2015年10月至2017年7月NobACS住院患者290例,依据RHI是否<1.67分为内皮功能障碍(abnormal endothelial function,AEF)组166例,内皮功能正常(normal endothelial function,NEF)组124例,随访(14.0±4.5)个月,记录AEs,包括全因死亡、缺血性卒中、非致命性心肌梗死和因心血管事件再次住院,通过生存分析比较两组AEs事件的差异。结果 AEF组、NEF组分别失访10例、7例。共有59例AEs事件发生。与NEF组比较,AEF组因心血管事件再次住院率显著升高(P<0.05),全因死亡、缺血性卒中、非致命性心肌梗死2组比较无统计学差异(P>0.05),总AEs事件率显著升高(P<0.01)。多因素Cox比例风险回归模型提示RHI<1.67(校正后HR=2.20,95%CI=1.24~3.92,P<0.01)是AEs事件的独立预测因子。结论 RHI可用于Nob ACS患者的中远期预后判断,RHI<1.67是NobACS患者预后的独立预测因子。

Objective To investigate the relationship between reactive hyperemia index （RHI） and midlongterm cardiac adverse events （AEs） in the patients with non-obstructive acute coronary syndrome （NobACS）. Methods A prospective cohort trial was carried out on 290 consecutive patients with NobACS admitted in our hospital from October 2015 to July 2017. According to their RHI, they were divided into abnormal endothelial function group （AEF, n=166, RHI〈1.67） and normal endothelial function group （NEF, n=124, RHI≥1.67）. The patients were averagely followed up for 14.0±4.5 months. AEs were defined as all-cause death, ischemic stroke, non-fatal myocardial infarction and re-hospitalization for cardiovascular events. Survival analysis was performed to compare the difference in AC occurrence between the 2 groups. Results There were 10 and 7 patients lost respectively in the AEF and NEF groups during the follow-up. AEs occurred in 59 patients. The AEs incidence （P〈0.01） and re-hospitalization rate （P〈0.05） were significantly higher in the AEF group than the NEF group. But there were no differences in the incidences of all-cause death, ischemic stroke and non-fatal myocardial infarction （P〉0.05）. Multifactor Cox proportional hazards regression model showed RHI〈1.67 （HR=2.20, 95%CI： 1.24～3.92, P〈0.01 after adjustment） was an independent prognostic factor for predicting AEs. Conclusion RHI could be used in prediction of mid-long-outcome of NobACS. RHI〈1.67 is an independent prognostic factor for NobACS.