静息心率与经皮冠状动脉介入术后短期预后的关系研究

Association between resting heart rate and short-term prognosis after percutaneous coronary intervention

目的:探讨经皮冠状动脉介入(PCI)术前的静息心率(HR)与术后30 d内预后的关系。方法:选择3720例行PCI术患者,均有明确术前静息HR记录及住院和术后30 d的随访临床结果。用五分位数分析静息HR和结果,再用二分法将HR<70次/min或≥70次/min的结果进行分析。结果:所有患者的平均静息HR为(70.9±14.7)次/min。五个百分位数的平均静息HR分别为:(54.8±5.3)、(63.7±1.6)、(69.9±1.5)、(77.1±2.5)、(93.4±13.1)次/min。出院后30 d内临床随访结果提示:5组患者之间,总死亡率、再发心肌梗死、靶病变血运重建、靶血管血运重建、主要不良心血管事件(MACE)和再入院治疗患者比例比较,差异有统计学意义(均P<0.05)。在HR<70次/min和≥70次/min的患者中,总死亡率、再发心肌梗死、靶病变血运重建、靶血管血运重建、MACE、再入院治疗患者比例比较,差异有统计学意义(均P<0.05)。按HR五分位数计算的患者中,随着HR升高,住院期间和出院后30 d内MACE发生率明显升高(P<0.01)。在HR≥70次/min的患者中,住院期间和出院后30 d内MACE发生率明显高于HR<70次/min的患者(P<0.05)。结论:PCI术前的静息HR在预测患者住院和短期心血管结局的风险方面具有重要作用,较高的静息HR预示着冠心病患者的预后较差。

Objective:To evaluate the relationship between resting heart rate(HR)before percutaneous coronary intervention(PCI)and prognosis within 30 days after PCI.Methods:Totally,3720 patients with PCI were selected and their resting HR was recorded before PCI and the clinical results were followed up for 30 days after PCI.The quintiles were used to analyze HR and results,and then dichotomy was used to analyze the results with HR<70 beats/min or≥70 beats/min.Results:The average resting HR of all patients was(70.9±14.7)beats/min.The average HR of the five percentiles was(54.8±5.3),(63.7±1.6),(69.9±1.5),(77.1±2.5)and(93.4±13.1)beats/min,respectively.The results of clinical follow-up within 30 days after discharge showed that there were significant differences in total mortality,recurrent myocardial infarction,target lesion revascularization,target vessel revascularization,major adverse cardiovascular events(MACE)and readmission among the 5 groups(all P<0.05).In patients with HR<70 and≥70 beats/min,there were significant differences in total mortality,recurrent myocardial infarction,target lesion revascularization,target vessel revascularization,MACE and readmission(all P<0.05).In patients calculated by HR quintile,the incidence of MACE increased significantly during hospitalization and within 30 days after discharge with the increase of HR(P<0.01).In patients with HR≥70 beats/min,MACE incidence during hospitalization and within 30 days after discharge was significantly higher than that in patients with HR<70 beats/min(P<0.05).Conclusion:Resting HR before PCI plays an important role in predicting the risk of hospitalization and short-term cardiovascular outcomes.Faster resting HR indicates poor prognosis in patients with coronary heart disease.