入院收缩压升高对行冠状动脉介入治疗的急性冠状动脉综合征患者远期预后的影响

Impact of Elevated Admission Systolic Blood Pressure on Long-term Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

目的:探讨入院收缩压升高对行冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者远期预后的影响。方法:连续入选2013-01至2013-12于中国医学科学院阜外医院接受PCI的ACS患者5 826例(包括4 261例不稳定性心绞痛患者)。根据入院收缩压水平将患者分为收缩压正常组[100~139 mmHg(1 mmHg=0.133 kPa),n=4 323]和收缩压升高组(≥140 mmHg,n=1 503),参照同一标准,进一步将4 261例不稳定性心绞痛患者根据入院收缩压水平分为收缩压正常者(n=3 034)和收缩压升高者(n=1 227)。比较不同分组患者2年内全因死亡率及主要不良心脑血管事件(MACCE,包括全因死亡、心肌梗死、支架内血栓、再次血运重建和脑卒中)发生率。采用多因素Cox回归分析患者预后不良的独立危险因素。结果:与收缩压正常组相比,收缩压升高组年龄较大[(61±10)岁vs(57±10)岁,P<0.001]、女性患者比例高(29.3%vs 21.6%,P<0.001)、合并症(高血压、糖尿病、高脂血症、心肌梗死史和脑血管病史)多,多支病变比例高(77.5%vs 71.0%,P<0.001)。两组患者全因死亡、MACCE以及心肌梗死和再次血运重建发生率的差异均无统计学意义(P均>0.05)。与收缩压正常组比较,收缩压升高组的支架内血栓发生率(1.3%vs 0.7%,P=0.048)和脑卒中(1.9%vs 1.2%,P=0.038)发生率增加。针对4 261例不稳定性心绞痛患者的进一步分析发现,收缩压升高者的支架内血栓和心肌梗死发生率高于收缩压正常者(P均<0.05)。Cox回归分析显示,收缩压升高不是支架内血栓和脑卒中的独立危险因素,高龄、既往发生脑血管意外的患者脑卒中风险增加。结论:ACS入院收缩压升高患者常伴随更多高危临床因素,但入院收缩压升高不是影响远期预后的独立危险因素。

Objectives： To investigate the prognostic value of elevated systolic blood pressure（SBP） at admission in patients with acute coronary syndrome（ACS） undergoing percutaneous coronary intervention（PCI）.Methods： A total of 5 826 consecutive ACS patients undergoing PCI were included. Patients were divided into normal admission SBP（100-139 mmHg, n=4 323） and elevated admission SBP(≥ 140 mmHg, n=1 503） groups. All-cause mortality and major adverse cardiovascular and cerebrovascular events（MACCE, including all-cause death, myocardial infarction（MI）, revascularization, in-stent thrombosis and stroke） during 2-year follow-up were compared between the two groups. Cox proportional hazard regression models were used to identify the independent risk factors of outcomes. The influence of admission SBP on the outcomes of subgroup patients with unstable angina（n=4 261） was also evaluated.Results： Patients were older（61 vs 57 years, P〈0.001）, proportions of females（29.3% vs 21.6%, P〈0.001）, concomitantmorbidities（such as hypertension, diabetes mellitus, hyperlipemia, previous MI and cerebral vascular disease） and multivessel lesions（77.5% vs 71.0%, P〈0.001） were significantly higher in elevated admission SBP group than in normal admission SBP group. During two-years follow-up, all-cause mortality, MACCE, MI and revascularization rates were comparable between two groups（all P〈0.05）. However, incidence of in-stent thrombosis（1.3% vs 0.7%, P =0.048） and stroke（1.9% vs 1.2%, P=0.038） were significantly higher in elevated admission SBP group than in normal admission SBP group. Subgroup analysis on patients with unstable angina showed that, incidence of in-stent thrombosis and MI were also significantly higher in elevated admission SBP group than in normal admission SBP group（both P〈0.05）. Cox regression analysis showed that elevated admission SBP was no longer an independent predictor of either in-stent thrombosis or stroke, and age and history of cerebrovascular disease were the independent risk factors of stroke. Conclusions： ACS patients with elevated admission SBP have more cardiovascular risk factors, but elevated admission SBP is not an independent risk factor of long-term outcomes in this patient cohort.