巴林急性冠脉综合征(ACS)患者的风险分层和医院道德。

The Open Cardiovascular Medicine Journal Pub Date : 2018-02-21 eCollection Date: 2018-01-01 DOI:10.2174/1874192401812010007
Taysir S Garadah, Khalid Bin Thani, Leena Sulibech, Ahmed A Jaradat, Mohamed E Al Alawi, Haytham Amin
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引用次数: 9

摘要

背景:巴林急性冠状动脉综合征(ACS)患者的危险因素和短期死亡率以前没有被评估过。目的:在这项前瞻性观察性研究中,我们旨在确定巴林ACS患者的临床风险概况,并描述其发病率、表现模式和入院后住院临床结果的预测因素。方法:前瞻性纳入ACS患者,为期12个月。这些患者的危险因素发生率与635名年龄和性别相匹配的非心脏病患者进行了比较。采用多元logistic回归分析预测ACS患者的不良预后。变量为年龄>65岁,体重指数(BMI) >28 kg/m2, GRACE(全球急性冠状动脉事件登记)评分>170,糖尿病史(DM),收缩期高血压>180 mmHg,肌酐水平>160 μmol/l,入院时心率(HR) >90 bpm,心电图上血清肌钙蛋白升高和ST段抬高。结果:连续入组635例ACS患者。平均年龄61.3±13.2岁,男性417例(65.6%)。st段抬高型心肌梗死(STEMI, n=156)与非STEMI (NSTEMI, n=158)和不稳定型心绞痛(UA, n=321)患者的平均年龄分别为56.5±12.8岁和62.5±14.0岁。STEMI、NSTEMI和UA患者的住院死亡率分别为5.1%、3.1%和2.5%。在STEMI患者中,88例(56.5%)患者接受了溶栓治疗,68例(43.5%)患者接受了初级冠状动脉成形术(PCI)。研究中不同临床变量对住院死亡率和心脏事件的预测值为:GRACE评分>170为2.8,DM为3.1,SBP >180 mmHg为2.2,年龄>65岁为1.4,BMI >28为1.8,肌酐>160 μmol/L为1.7,HR >90 bpm为2.1,血清肌钙蛋白阳性为2.2,ST段抬高为2.3。结论:与非STEMI和UA患者相比,STEMI患者年龄更小。与非STEMI和UA患者相比,STEMI患者的住院死亡率更高。急性冠脉综合征患者入院时死亡或心脏事件的最显著预测因子为糖尿病、GRACE评分>170、收缩期高血压>180 mmHg、血清肌钙蛋白阳性和HR >90 bpm。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain.

Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain.

Risk Stratification and in Hospital Morality in Patients Presenting with Acute Coronary Syndrome (ACS) in Bahrain.

Background: Risk factors and short-term mortality in patients presented with Acute Coronary Syndrome (ACS) in Bahrain has not been evaluated before.

Aim: In this prospective observational study, we aim to determine the clinical risk profiles of patients with ACS in Bahrain and describe the incidence, pattern of presentation and predictors of in-hospital clinical outcomes after admission.

Methods: Patients with ACS were prospectively enrolled over a 12 month period. The rate of incidence of risk factors in patients was compared with 635 non-cardiac patient admissions that matched for age and gender. Multiple logistic regression analysis was used to predict poor outcomes in patients with ACS. The variables were ages >65 years, body mass index (BMI) >28 kg/m2, GRACE (Global Registry of Acute Coronary Events) score >170, history of diabetes mellitus (DM), systolic hypertension >180 mmHg, level of creatinine >160 μmol/l and Heart Rate (HR) on admission >90 bpm, serum troponin rise and ST segment elevation on the ECG.

Results: Patients with ACS (n=635) were enrolled consecutively. Mean age was 61.3 ± 13.2 years, with 417 (65.6%) male. Mean age for patients with ST-segment elevation myocardial infarction (STEMI, n=156) compared with non-STEMI (NSTEMI, n=158) and unstable angina (UA, n=321) was 56.5± 12.8 vs 62.5±14.0 years respectively. In-hospital mortality was 5.1%, 3.1% and 2.5% for patients with STEMI, NSTEMI, and UA, respectively. In STEMI patients, thrombolytic therapy was performed in 88 (56.5%) patients and 68 (43.5%) had primary coronary angioplasty (PCI). The predictive value of different clinical variables for in-hospital mortality and cardiac events in the study were: 2.8 for GRACE score >170, 3.1 for DM, 2.2 for SBP >180 mmHg, 1.4 for age >65 years, 1.8 for BMI >28, 1.7 for creatinine >160 μmol/L, 2.1 for HR >90 bpm, 2.2 for positive serum troponin and 2.3 for ST elevation.

Conclusion: Patients with STEMI compared with NSTEMI and UA were of younger age. There was higher in-hospital mortality in STEMI compared with NSTEMI and UA patients. The most significant predictors of death or cardiac events on admission in ACS were DM, GRACE Score >170, systolic hypertension >180 mmHg, positive serum troponin and HR >90 bpm.

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