代谢综合征对老年ST段抬高型心肌梗死患者短期预后的影响

Effect of metabolic syndrome on short-term major adverse cardiovascular events in elderly patients with ST-segment elevation myocardial infarction

目的:探索在老年ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)人群中,代谢综合征(metabolic syndrome,MS)对30d主要不良心血管事件(major adverse cardiovascular events,MACE)的影响。方法:本研究为单中心回顾性队列研究,最终入选老年STEMI患者325例。所有患者根据是否合并MS分为两组:无MS组(n=156)及MS组(n=169)。主要终点:30d MACE,包括全因死亡、再发心肌梗死、心源性休克和心力衰竭再住院。次要终点:MACE各独立组成部分。通过Logistic回归分析探究MS与30d MACE之间的关系,结果使用比值比(OR)和95%置信区间(CI)表示。使用亚组分析探究在不同亚组中MS对30d MACE的影响并绘制森林图。结果:在老年STEMI患者中,MS组患者的30d MACE发生率显著高于无MS组(12,7.7%vs.26,15.4%,P<0.05),主要是由于MS组患者的心源性休克(1,0.6%vs.15,8.9%,P<0.05)和心力衰竭再住院(2,1.3%vs.13,7.7%,P<0.05)的发生率显著高于无MS组。多元Logistic回归分析表明:MS组较无MS组30天MACE的发生风险显著增加(OR=2.34,95%CI:1.09~5.05,P=0.030)。在亚组分析中,并未发现MS与其他危险因素存在显著的交互作用。结论:在老年STEMI患者中,MS是30d MACE发生的独立危险因素,可显著增加30d MACE的发生风险。

Objective:The prevalence of metabolic syndrome(MS)is increasing every year,posing a serious risk to public cardiovascular health.Patients with ST-segment elevation myocardial infarction(STEMI)and MS tend to have a worse prognosis.However,there are no studies on the short-term prognosis of STEMI patients with MS in the Asian elderly population.Therefore,the purpose of this study was to explore the effect of MS on the occurrence of 30-day major adverse cardiovascular events(MACE)in the elderly Chinese STEMI population.Methods:The study was a single-center retrospective cohort study,and 325 elderly STEMI patients were finally enrolled.All patients were divided into two groups according to whether they had MS:no MS group(n=156)and MS group(n=169).Primary endpoint:30-day MACE,including all-cause mortality,recurrent myocardial infarction,cardiogenic shock and heart failure rehospitalization.Secondary endpoint:each component of MACE.The association between MS and 30-day MACE was explored by logistic regression analysis,and results were expressed using OR and 95%CI.The effect of MS on 30-day MACE in different subgroups was explored using subgroup analysis and plotted in forest plots,with results expressed as OR,95%CI and interaction P value.Results:In elderly patients with STEMI,the incidence of 30-day MACE was significantly higher in the MS group than in the no-MS group(no-MS group vs.MS group:12,7.7%vs.26,15.4%,P<0.05),mainly due to cardiogenic shock(no-MS group vs.MS group:1,0.6%vs.15,8.9%,P<0.05)and heart failure rehospitalization(no-MS group vs.MS group:2,1.3%vs.13,7.7%,P<0.05).Multiple logistic regression analysis showed that the risk of MACE was significantly increased in the MS group compared with the no-MS group(OR=2.34,95%CI:1.09-5.05,P=0.030).In subgroup analysis,no significant interaction between MS and other risk factors was found.Conclusions:In elderly STEMI patients,MS was an independent risk factor for the development of 30-day MACE and significantly increased the risk of 30-day MACE.