血压与急性心肌梗死患者院内心源性猝死的关系

Relationship between blood pressure and sudden cardiac death in AMI patients

目的探索高血压以及不同血压水平与急性心肌梗死(acute myocardial infarction,AMI)患者院内心源性猝死(sudden cardiac death,SCD)的关系。方法收集2008年8月~2021年7月解放军总医院因AMI入院且院内发生SCD的患者165例,收集同期未发生SCD的患者363例,收集患者的一般资料及临床指标,采用最临近匹配法,对AMI类型、性别及年龄进行1:1倾向性评分匹配,以平衡相关指标的偏倚,最终猝死组157例,非猝死组157例。以院内发生SCD为结局进行多因素logistic回归分析。结果猝死组收缩压、LVEF、血红蛋白、白蛋白低于非猝死组,C反应蛋白、纤维蛋白原、D-二聚体、天冬氨酸转氨酶、肌钙蛋白T、肌酐、磷、镁、钾、肌红蛋白、肌酸激酶同工酶、N末端B型钠尿肽前体显著高于非猝死组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,高血压、脑卒中及收缩压水平均是AMI患者院内发生SCD的独立影响因素(OR=1.811,95%CI:1.043~3.146,P=0.035;OR=1.809,95%CI:1.037~3.154,P=0.037;OR=0.976,95%CI:0.965~0.987,P=0.000)。将收缩压细分为8组数据,多因素logistic回归分析显示,与收缩压<110 mm Hg(1 mm Hg=0.133 kPa)相比,收缩压≥130 mm Hg院内发生SCD风险均降低,其中140~149 mm Hg院内发生SCD风险最低(OR=0.130,95%CI:0.049~0.346,P=0.000)。结论合并高血压会显著升高AMI患者院内发生SCD风险,而收缩压140~149 mm Hg院内发生SCD风险最低。

Objective To study the relationship between hypertension and blood pressure with sudden cardiac death(SCD) in patients with acute myocardial infarction(AMI).Methods One hundred and sixty-five AMI patients with SCD and 363 AMI patients without SCD admitted to our hospital from August 2008 to July 2021 were included in this study.Their general clinical data and indicators were recorded.The age, gender and types of AMI were matched by 1:1 propensity score matching(PSM) to balance the bias of related clinical indicators.Finally, 314 patints were divided into SCD group(n=157) and SCD-free group(n=157).The relationship of hypertension and blood pressure with SCD in AMI patients was analyzed by multivariate logistic regression analysis.Results The SBP,LVEF,serum levels of hemoglobin and albumin were significantly lower while the serum levels of CRP,fibrinogen, D-dimer, aspartate aminotransferase, troponin T,creatinine, phosphorus, magnesium, potassium, myoglobin, creatine kinase isoenzyme and NT-proBNP were significantly higher in SCD group than in SCD-free group(P<0.05,P<0.01).Multivariate logistic regression showed that hypertension, stroke and SBP were independent risk factors for SCD in AMI patients(OR=1.811,95%CI:1.043-3.146,P=0.035;OR=1.809,95%CI:1.037-3.154,P=0.037;OR=0.976,95%CI:0.965-0.987,P=0.000),the risk of inhospital SCD was lower when the SBP was ≥130 mm Hg than when the SBP was<110 mm Hg, and was the lowest when the SBP was 140-149 mm Hg(OR=0.130,95%CI:0.049-0.346,P=0.000).Conclusion Hypertension can significantly increase the risk of inhospital SCD which is the lowest when the SBP is 140-149 mm Hg in AMI patients.