我国非ST段抬高急性冠状动脉综合征患者猝死或心律失常死亡事件危险因素分析
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OASIS协作组梁岩 谭慧琼 朱俊 章晏 刘力生
【摘要】 目的 研究分析OASIS登记试验中国地区所有入选的非ST段抬高急性冠状动脉综合征(ACS)患者2年随访结束时，猝死及心律失常死亡事件的发生及与多种因素之间的关系。方法总结所有入选患者从入院至2年随访结束时主要死亡事件的发生情况及生存时间，并采用生存分析(Cox回归)模型，分析患者就诊时一般情况、既往病史、住院与随访期间治疗及不良事件发生等77种因素在患者生存时间中所起的作用。结果共注册ACS患者2 294例，总死亡数为174例，主要死因为猝死或心律失常(占52.9%)。增加死亡的主要危险因素有：出院后随访期间的心肌梗死(心梗)频数，首次住院期间24 h内心梗事件，首次住院期间心力衰竭事件，既往心梗病史，首次住院期间复发性心绞痛，首次住院天数，患者年龄。减少死亡的保护因素有：出院后随访期间应用硝酸酯类药物频数，出院后随访期间应用抗血小板药物频数，出院后随访期间应用β受体阻滞剂频数。结论 我国非ST段抬高ACS患者2年随访中以猝死或心律失常死亡为第一位死因，死亡主要与患者冠心病严重程度和年龄有关。药物治疗，特别是硝酸酯类药物、阿司匹林和β受体阻滞剂对主要死亡有保护作用。
【关键词】 非ST段抬高急性冠状动脉综合征； 心律失常； 死亡原因； Cox回归分析
Risk factors of sudden death and death from arrhythmia in patients with non-ST elevation acute coronary syndromes in China LIANG Yan, TAN Hui-qiong, ZHU Jun, ZHANG Yan, liu Li-sheng.Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
OBJECTIVE: To analyze the relationship between sudden death and death from arrhythmia and multiple risk factors in patients with non-ST elevation acute coronary syndromes in two years of follow-up in China. METHODS: This study was a part of an international multicentre registry-Organization to Assess Strategies for Ischemic Syndromes (OASIS). The patients admitted to the hospital with non-ST elevation acute coronary syndrome were enrolled. No particular intervention was given for the treatment. All patients had been followed-up for two years. The patients' clinical characteristics, therapeutic regimes and major events during hospitalization and two years' follow-up period were recorded by filling in Case Report Forms according to the protocol offered by Canadian Cardiovascular Collaboration. Cox regression model was used to analyze the association with the most common causes of death and multiple factors recorded. RESULTS: From April 1999 to December 2001, 2294 cases were enrolled in 38 hospitals in China nationwide. Among them 2188 patients two years follow-up was accomplished. The mean age of the patients was (62.8±8.1) years. Male gender was dominant (62.3%). The clinical diagnosis at admission was unstable angina in 88.5% of the patients and non Q-wave myocardial infarction(MI) in the remaining 11.5%. The mortality was 7.6% with total deaths of 174 by the end of 24-month follow up. The most common cause of death was severe arrhythmias or sudden death (92 cases, 52.9%). More than 70 factors were analyzed by Cox regression model in order to determine which were the predominant factors of death. Major risk factors that predisposed to death were: number of episodes of MI during follow-up period, re-MI within 24 hours during hospitalization, heart failure during hospitalization, previous history of MI, recurrent angina pectoris during hospitalization, the duration of hospitalization, and patient age. Protective factors that reduced the chance of death were: the frequency of using nitrate, frequency of taking anti-platelet medicine or β-blocker during follow-up period. CONCULSION: In China, the most common cause of death in patients with non-ST elevation acute coronary syndromes is severe arrhythmias or sudden death, and it is related with the severity of coronary artery disease and the age of patients in majority of cases. Some factors that influence survival are similar to those established by previous evidence based medicine. ......
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