中国全科医学2017，Vol.20Issue(13)：1573-1581,9.DOI:10.3969/j.issn.1007-9572.2017.13.010
贫血对置入支架的急性冠脉综合征合并心房颤动患者病情及预后的影响研究
Effect of Anemia on Acute Coronary Syndrome Patients Combined with Atrial Fibrillation Undergoing Percutaneous Comary Interventions
摘要
Abstract
Objective To discuss the effect of anemia on the condition and prognosis of acute coronary syndrome (ACS) patients combined with atrial fibrillation (AF) who had underwent percutaneous comary interventions (PCI).Methods By retrieving electronic medical record bases,3 156 ACS patients combined with AF undergoing PCI in 12 Beijing hospitals such as Beijing Anzhen Hospital,Capital Medical University,Fuwai Hospital,Chinese Academy of Medical Sciences,Chinese PLA General Hospital,and Navy General Hospital of the Chinese People′s Liberation Army from January 1, 2010 to January 31, 2015 were enrolled to make a multi-center retrospective study.According to hemoglobin,they were divided into anemia group (n=865) and non-anemic group (n=2 291).General information including basic information,past history,laboratory tests,ultrasonography of cardiac function between two groups was collected.The score of GRACE,CRUSADE,HAS-BLED,CHADS2,CHA2DS2-VASc was conducted according to the uniform scoring criteria.A follow-up till March 20,2016 was made to record the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding events.Results The age,length of hospital stay,height,body weight,body mass index (BMI),diastolic blood pressure,white blood cell count,haematocrit,red blood cell volume distribution width,serum creatinine (SCr),blood urea nitrogen(BUN),serum uric acid (SUA),blood albumin (ALB),endogenous creatinine clearance rate (CCr),and prothrombin activity were significantly different between two groups (P<0.05).There was no significant difference in heart rate,systolic blood pressure,red blood cell count,fasting plasma glucose (FPG),serum potassium,left ventricular ejection fraction (LVEF) and international standardized ratio (INR) between two groups (P>0.05).There was significant difference in gender,smoking history,drinking history,history of hypertension,history of diabetes,history of stroke,previous history of vascular disease,incidence of cardiac insufficiency,incidence of renal insufficiency,positive rate of occult blood,history of pacemaker implantation,Killip classification,New York Heart Association (NYHA) classification,ACS type,AF type between two groups (P<0.05);there was no significant difference in the history of PCI,history of coronary heart disease,the family history of coronary heart disease,incidence of hepatic insufficiency and incidence of hyperuricemia between two groups (P>0.05).The score of GRACE,CRUSADE,HAS-BLED,CHADS2 and CHA2DS2-VASc were significantly different between two groups (P<0.05).There were significant differences in incidence of MACCEs and all-cause deaths between two groups (P<0.05).There was no significant difference in the incidences of nonfatal myocardial infarction,nonfatal stroke and target vessel revascularization between two groups (P>0.05).There was significant difference in the incidences of massive haemorrhage and minor bleeding between two groups (P<0.05).There was no significant difference in the total incidences of massive haemorrhage and minor bleeding between two groups (P>0.05).The Kaplan-Meier survival curves of MACCEs and all-cause deaths event were significantly different between two groups (P<0.05).The Kaplan-Meier survival curves of nonfatal myocardial infarction events,nonfatal stroke events,target vessel revascularization events,and bleeding events were not significantly different between two groups (P>0.05).Multivariate Cox proportional hazards regression model analysis showed that the white blood cell count,hemoglobin,red blood cell volume distribution width,FPG,ALB,LVEF,previous PCI history,stroke history,positive occult blood,and NYHA classification were the risk factors of MACCEs (P<0.05).Conclusion ACS patients combined with AF in anemic condition have a higher incidence of MACCEs and all-cause mortality.Anemia can be used as a predictive factor of the risk of MACCEs in ACS patients with AF.关键词
急性冠状动脉综合征/心房颤动/贫血/支架/预后Key words
Acute coronary syndrome/Atrial fibrillation/Anemia/Stents/Prognosis分类
医药卫生引用本文复制引用
张博阳,陈韵岱,宋康兴,唐熠达,郭成军,李运田,马志敏,王显,黄党生,王守力,李田昌,刘鹏飞,王楠楠,王宇彬,刘如晨,谢秀峰,袁海凤,唐海红,王峰..贫血对置入支架的急性冠脉综合征合并心房颤动患者病情及预后的影响研究[J].中国全科医学,2017,20(13):1573-1581,9.基金项目
首都临床特色应用研究与成果推广(Z151100004015205) （Z151100004015205）
