急诊入院急性冠脉综合征患者近期预后的危险因素分析

Risk factors for short-term prognosis in patients with acute coronary syndrome admitted to emergency department

目的:探讨影响急诊入院急性冠脉综合征(ACS)患者近期预后的危险因素。方法:回顾性分析胸痛、胸闷急诊入院的154例患者的临床资料。根据出院后1个月内是否死亡分为存活组(134例)与死亡组(20例),采用多因素Cox回归分析影响急诊入院ACS患者近期预后的危险因素。结果:死亡组患者年龄较存活组大[(76.0±11.3)岁vs(62.5±10.3)岁,P<0.01],合并糖尿病的患者比例较存活组明显增加(35.0%vs 18.7%,P<0.05);平均住院时间显著短于存活组[(5.0±5.3)d vs(12.3±6.0)d,P<0.01];胸痛就诊时间显著长于存活组[(12.3±6.0)d vs(5.0±5.3)d,P<0.05]。死亡组患者舒张压水平较存活组显著下降(P<0.05),心率较存活组增快(P<0.01),脑钠肽(BNP)水平及心肌肌钙蛋白(cTnI)最高值均较存活组增高(P<0.01或P<0.05)。Cox多因素回归分析发现,年龄(OR:95%CI,1.134:1.061~1.212,P<0.001)、院前心脏骤停(OR:95%CI,8.946:1.607~49.815,P=0.012)、舒张压(OR:95%CI,0.965:0.938~0.994,P=0.016)、心率(OR:95%CI,1.049:1.020~1.079,P=0.001)、胸痛就诊时间(OR:95%CI,1.023:1.002~1.045,P=0.032)是影响急诊入院ACS患者近期预后的危险因素。结论:年龄较大、院前心脏骤停、胸痛就诊时间较长、舒张压低、心率快是影响急诊入院ACS患者近期预后的危险因素。

Objective:To investigate the risk factors affecting the short-term prognosis of acute coronary syndrome(ACS)patients admitted in the emergency department.Methods:A retrospective analysis was performed on 154 patients admitted to hospital for diagnosis of ACS due to chest pain and chest tightness.The patients were divided into survival group(n=134)and death group(n=20)according to death or not 1 month after discharge.The multivariate Cox regression analysis was used to analyze the risk factors of the short-term prognosis in patients with ACS during emergency admission.Results:The patients in the death group were significantly older[(76.0±11.3)years vs(62.5±10.3)years,P<0.01]and the death group had a significantly greater proportion of diabetes mellitus than in the survival group(35.0%vs 18.7%,P<0.05).The average length of hospital stay in the death group was significantly shorter than that in the survival group[(5.0±5.3)days vs(12.3±6.0)days,P<0.01].Delay in chest pain in the death group was significantly longer than in the survival group[(12.3±6.0)days vs(5.0±5.3)days,P<0.05].The diastolic blood pressure in the death group was significantly lower than that in the survival group(P<0.05).The heart rate in the death group was faster than that in the survival group(P<0.01).Both the BNP level and the highest cTnI value in the death group were higher than those in the survival group(P<0.05 or P<0.01).Cox multivariate regression analysis revealed that age(OR:95%CI,1.134:1.061-1.212,P<0.001),prehospital cardiac arrest(OR:95%CI,8.946:1.607-49.815,P=0.012),diastolic blood pressure(OR:95%CI,0.965:0.938-0.994,P=0.016),heart rate(OR:95%CI,1.049:1.020-1.079,P=0.001),and delay in chest pain(OR:95%CI,1.023:1.002-1.045,P=0.032)were the risk factors influencing the short-term prognosis of ACS patients admitted in the emergency department.Conclusions:Older age,prehospital cardiac arrest,longer duration of chest pain,lower diastolic blood pressure,and faster heart rate are all risk factors that affect the short-term prognosis of ACS patients admitted in the emergency department.