急性冠脉综合征合并缺血性脑卒中患者的临床特点

Clinical features of acute coronary syndrome patients with prior ischemic stroke

回顾性收集2014年11月至2017年7月苏北人民医院急性冠脉综合征(ACS)患者,每月连续录入20~30例,共637例。按照是否有缺血性脑卒中分为合并组与对照组,分析危险因素、既往史、冠状动脉严重程度、用药情况及在院期间不良心脑血管事件(心源性死亡、再发心肌梗死、心力衰竭、新发脑卒中)等变量的差异。本研究中,ACS患者伴缺血性脑卒中者患病率为7.5%(48/637)。合并组β受体阻滞剂使用率[50.00%(24/48)比69.78%(411/589),χ^2=8.02,P<0.05]及介入治疗[56.67%(17/30)比81.86%(334/408),χ^2=11.15,P<0.05]比例较对照组低,差异有统计学意义。而双联抗血小板、他汀及血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂使用率组间差异无统计学意义。在院期间主要心脑血管不良事件发生率差异无统计学意义。目前我院ACS伴既往缺血性脑卒中患者治疗率与国外相关研究类似,均存在一定程度用药比率低的问题,需有更多研究关注此类患者的临床管理。

From November 2014 to July 2017,637 patients with acute coronary syndrome(ACS)were included in the analysis,among whom there were 48 cases with prior ischemic stroke(7.5%).The risk factors,history,severity of coronary artery disease,medication status,and incidence of adverse cardiovascular and cerebrovascular events(cardiac death,re-infarction,heart failure,stroke)were analyzed.Compare with patients without prior ischemic stroke(control group)patients with prior ischemic stroke(study group)had lower rates in administration of beta blockers[50.00%(24/28)vs.69.78%(411/589),χ^2=8.02,P<0.05]and interventional therapy[56.67%(17/30)vs.81.86%(334/408),χ^2=11.15,P<0.05].However,there were no significant differences in medication of dual antiplatelet,statins and angiotensin converting enzyme inhibitors or angiotensin receptor blocker between two groups(P>0.05);and there was no significant difference in major adverse cardiovascular events between two groups(P>0.05).In the future,more studies are needed for clinical management of this group of patients.