急性心肌梗死患者发病前心血管-肾脏-代谢综合征分期特征分析

Assessment of cardiovascular-kidney-metabolic syndrome staging in the pre-infarction phase of acute myocardial infarction patients

目的探讨急性心肌梗死(AMI)患者发病前心血管-肾脏-代谢(CKM)综合征各分期的患者比例及相关特征。方法纳入2017年1月至2022年12月首都医科大学宣武医院入院的AMI患者,依据美国心脏协会对CKM综合征定义将患者分为0~4期,并根据不同年龄(<55岁、55~74岁、≥75岁)、性别分组,描述各组CKM不同分期的患者比例及临床特征。使用线性回归分析或Cochran-Armitage趋势检验评估CKM分期与各临床指标之间是否存在线性趋势关系。结果本研究共纳入2580例AMI患者,CKM综合征0~4期的患者人数分别为69例(2.7%)、201例(7.8%)、512例(19.8%)、970例(37.6%)以及828例(32.1%)。女性AMI患者发病前CKM3~4期的患者比例相较于男性更多(72.5%比68.9%,P<0.01)。与55岁以上各年龄组相比,<55岁组AMI患者在发病前CKM3~4期占比最少(50.3%,P<0.01)。随着CKM综合征分期升高,患者发生AMI后左心室射血分数更低,N末端B型利钠肽前体(NT-proBNP)值水平更高,急性非ST段抬高型心肌梗死的患者比例更高(趋势P均<0.01)。结论AMI患者发病前超半数为CKM 3~4期人群。CKM分期能有效筛选AMI发病高危人群,但仍需加强对CKM 0~2期人群中AMI高危人群的早期识别及干预。

Objective To investigate the prevalence and distribution of cardiovascular-kidney-metabolic(CKM)syndrome stages among patients prior to their acute myocardial infarction(AMI).Methods The patients diagnosed with AMI and admitted to Xuanwu Hospital of Capital Medical University from January 2017 to December 2022 were included.CKM syndrome was classified from stage 0 to stage 4 according to the definition by the American Heart Association.The patients were categorized by age(<55,55-74,≥75 years)and gender to analyze CKM stage distribution and clinical characteristics within each group.Linear regression and the Cochran-Armitage trend test were used to assess the linear trend between CKM staging and various clinical indicators.Results A total of 2580 AMI patients were included.The distribution across CKM syndrome stages ranging from 0 to 4 was 69 patients(2.7%),201 patients(7.8%),512 patients(19.8%),970 patients(37.6%)and 828 patients(32.1%),respectively.A higher proportion of females exhibited advanced CKM syndrome(stages 3-4)before AMI compared to males(72.5%vs.68.9%,P<0.01).Among different age groups,the youngest cohort(<55 years)showed the lowest prevalence of advanced CKM syndrome(50.3%,P<0.01),contrasting with the 55-74 and≥75 age groups.With the progression of CKM syndrome staging,patients with AMI exhibit a lower left ventricular ejection fraction,higher levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),and a greater proportion of patients with acute non-ST-segment elevation myocardial infarction(P for trend<0.01).Conclusion A significant majority of AMI patients present with CKM stages 3 to 4 before the onset of AMI.CKM staging could effectively identifie high-risk populations for AMI,yet there is a need to enhance early identification and intervention for AMI high-risk patients in the CKM stages 0 to 2.