老年急性冠状动脉综合征合并心律失常患者临床特征及预后分析

Clinical features and prognosis analysis of aged patients with acute coronary syndrome complicated arrhythmia

目的:探讨老年急性冠状动脉综合征(ACS)合并心律失常患者的临床特征及预后。方法:根据预后情况,于我院治疗的220例老年ACS合并心律失常患者被分为生存组(148例)与死亡组(72例)。比较两组一般临床资料,并分析患者死亡的影响因素。结果:与生存组比较,死亡组的纽约心脏病学会(NYHA)心功能分级Ⅲ~Ⅳ级(27.03%比58.33%)、发病至就诊时间≥72h(16.22%比38.89%)、频发室性早搏(21.62%比55.56%)、室性心动过速次数≥5次比例(27.03%比58.33%)均显著升高;发病至就诊时间24~72h比例(39.19%比25.00%)、出院治疗使用阿司匹林(95.95%比86.11%)、他汀类比例(94.95%比86.11%)、房颤/房扑比例(44.59%比19.44%)均显著降低(P<0.05或<0.01)。多因素Logistic回归分析提示:NYHAⅢ~Ⅳ级、发病至就诊时间≥72h、室性心动过速、频发室性早搏是此类患者死亡的独立危险因素(OR=2.700~5.893,P均<0.01)。结论:NYHA心功能分级、发病至就诊时间、频发室性早搏、室性心动过速对ACS合并心律失常患者死亡有显著影响。

Objective:To explore clinical features and prognosis of aged patients with acute coronary syndrome(ACS)complicated arrhythmia.Methods:According to prognosis,a total of 220 aged ACS patients with arrhythmia in our hospital were divided into survival group(n=148)and death group(n=72).General clinical data were compared between two groups,and influencing factors for death were analyzed in these patients.Results:Compared with survival group,there were significant rise in percentages of New York heart association(NYHA)cardiac function classⅢ~Ⅳ(27.03%vs.58.33%),onset-to-visit time≥72h(16.22%vs.38.89%),frequent ventricular premature beats(21.62%vs.55.56%)and frequency of ventricular tachycardia≥5 times(27.03%vs.58.33%),and significant reductions in percentages of onset-to-visit time 24~72h(39.19%vs.25.00%),use of aspirin(95.95%vs.86.11%)and statins(94.95%vs.86.11%)after discharge and atrial fibrillation/atrial flutter(44.59%vs.19.44%)in death group(P<0.05 or<0.01).Multivariate Logistic regression analysis indicated that NYHA cardiac function classⅢ~Ⅳ,onset-to-visit time≥72h,ventricular tachycardia and frequent ventricular premature beats were independent risk factors for death in these patients(OR=2.700~5.893,P<0.01 all).Conclusion:NYHA cardiac function class,onset-to-visit time,frequent ventricular premature beats and ventricular tachycardia possess significant influence on death for patients with acute coronary syndrome complicated arrhythmia.