具有适应证的ACS住院患者早期口服β受体阻滞剂的现状及其与院内结局的关系

The current status of early use of oralβ-blockers in patients with acute coronary syndrome and the association with the in-hospital outcomes

目的:分析具有适应证的急性冠状动脉综合征(ACS)住院患者早期口服β受体阻滞剂的现状及其与院内结局的关系。方法:本研究基于中华医学会心血管病学分会(CSC)和美国心脏协会(AHA)合作的中国心血管疾病医疗质量改善项目(CCC)。CCC项目是一项注册研究,自2014年起,在全国158家三级医院和82家二级医院连续入选ACS住院患者,系统地收集患者临床相关信息。本研究纳入CCC项目2014年11月至2019年7月收集的具有早期口服β受体阻滞剂适应证的ACS住院患者,将入选患者按照入院后24 h内是否口服β受体阻滞剂分为口服组和未口服组,分析患者早期口服β受体阻滞剂的情况,并采用倾向性评分匹配和多因素Cox风险回归模型分析早期口服β受体阻滞剂与院内15 d结局发生风险的关系。结果:本研究共纳入230家医院,38 663例具有早期口服β受体阻滞剂适应证的ACS住院患者,年龄(57.0±9.0)岁,其中男性78.8%(30 470/38 663)。ACS住院患者早期β受体阻滞剂的服用率为64.9%(25 112/38 663),在全国230家医院中,服用率从0到100%,存在明显差异。经倾向性评分匹配后,口服组院内15 d主要心血管不良事件(MACE)发生率低于未口服组[2.9%(339/11 536)比3.4%(395/11 536), P=0.036],心力衰竭的发生率低于未口服组[2.1%(248/11 536)比2.7%(316/11 536), P=0.004]。多因素Cox风险回归模型分析结果显示,口服组MACE的发生风险较未口服组低15.5%( HR=0.845,95% CI:0.731~0.978),心力衰竭和心原性休克的发生风险分别较未口服组患者低23.1%( HR=0.769,95% CI:0.651~0.909)和35.3%( HR=0.647,95% CI:0.422~0.992)( P均<0.05)。 结论:在我国临床实践中,具有适应证的ACS住院患者早期β受体阻滞剂应用不足,且早期使用率在全国230家医院间存在着较大差异。与早期未口服β受体阻滞剂组的ACS患者相比,早期口服β受体阻滞剂的患者MACE事件、心力衰竭和心原性休克发生风险较低。

Objective To analyze the status of early use of oralβ-blocker and its relationship with in-hospital outcomes in eligible patients with acute coronary syndrome(ACS).Methods The study was based on the Improving Care for Cardiovascular Disease in China(CCC)-ACS project.The data of ACS patients that collected during 2014 to 2019 from 230 collaborating hospitals across China were analyzed.Propensity score matching method and Cox multivariate regression analysis were used to analyze the association between early use of oralβ-blocker and in-hospital outcomes within 15 days.Results A total of 38663 eligible ACS patients were included in this study.The mean age was(57.0±9.0),and 78.8%of the ACS patients(30470/38663)were male.The proportion of early use of oralβ-blockers was 64.9%(25112/38663),but varied substantially,in the 230 hospitals with a range from 0 to 100%.Compared with the patients no early use of oralβ-blocker,the patients receiving early oralβ-blocker had significantly lower incidence of major cardiovascular adverse events(MACEs)(3.4%(395/11536)vs.2.9%(339/11536),P=0.036)and less occurrences of heart failure(2.7%(316/11536)vs.2.1%(248/11536),P=0.004).Multivariate Cox regression analyses showed the patients receiving early oralβ-blocker had 15.5%,23.1%,and 35.3%lower risks of MACEs,heart failure and cardiogenic shock respectively than the patients no early oralβ-blocker.Conclusions Compared with the patients no early oralβ-blocker,the patients receiving early oralβ-blocker had lower risks of MACEs events,heart failure and cardiogenic shock.However,the early use of oralβ-blocker in ACS patients was generally insufficient with huge differences among different hospitals in China.