术前血压水平与经皮冠状动脉介入治疗急性心肌梗死患者预后的关系
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摘要
目的探讨急性心肌梗死(AMI)接受经皮冠状动脉介入治疗(PCI)患者术前收缩压/舒张压与主要不良心脑血管事件(MACCE)之间的关系。方法选取2015年1月至2016年1月期间收治的AMI行PCI治疗的住院患者582例,根据收缩压与舒张压水平分别单独排序,采用5分位数将收缩压与舒张压各分成5组:收缩压组1[(94.4±5.6),≤104 mm Hg],收缩压组2[(107.7±3.6),105～111 mm Hg],收缩压组3[(115.6±3.5),112～121 mm Hg],收缩压组4[(138.5±3.0),122～144 mm Hg],收缩压组5[(144.8±4.3),≥145 mm Hg]。舒张压组1[(56.5±3.5),≤61 mm Hg],舒张压组2[(64.8±1.8),62～66 mm Hg],舒张压组3[(68.7±1.9),67～73 mm Hg],舒张压组4[(75.2±2.2),74～79 mm Hg],舒张压组5[(84.6±4.7),80～90 mm Hg]。比较各组患者的临床特点;采用多因素Cox风险模型预测MACCE发生的影响因素。结果收缩压组1及舒张压组1患者体质量指数(BMI)、入院时心率低于其余4组患者(均P<0.05),收缩压组5及舒张压组5患者高血压比例高于其余4组患者(P<0.05)。收缩压组1及舒张压组1患者高密度脂蛋白胆固醇(HDL-C)高于其余4组患者(P<0.05)。收缩压组1与舒张压组1患者的血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)使用比例低于其余4组患者(P<0.05)。多因素Cox风险回归分析显示,AMI患者在PCI术前时收缩压≤104 mm Hg(HR 2.052)、收缩压≥145 mm Hg(HR 2.205)、舒张压≤61 mm Hg(HR 1.359)、舒张压≥80 mm Hg(HR 1.490)、年龄(HR 3.325)、Killip分级(3/4)(HR 11.687)是MACCE发生的独立危险因素。ACEI/ARB的使用(HR 0.204)是AMI患者MACCE发生的独立保护因素。收缩压/舒张压与MACCE发生之间呈现U形关系。结论 PCI术前AMI患者收缩压≤104或≥145 mm Hg,舒张压≤61或≥80 mm Hg可能是PCI术后MACCE发生的独立危险因素;收缩压/舒张压与MACCE发生之间均呈现U形关系。
Objective To investigate the relationship between systolic/diastolic blood pressure before percutaneous coronary intervention(PCI) and major adverse cardio-cerebrovascular events(MACCE) in patients with acute myocardial infarction(AMI). Methods Five hundred and eighty two patients with AMI treated by PCI from January 2015 to January 2016 were selected. According to the level of systolic and diastolic blood pressure, they were sorted separately and divided into five groups by 5-quartile: systolic blood pressure group-1 [(94.4±5.6), range ≤104 mm Hg], systolic blood pressure group-2 [(107.7±3.6), range 105-111 mm Hg], systolic blood pressure group-3 [(115.6±3.5), range 112-121 mm Hg], systolic blood pressure group-4 [(138.5±3.0), range 122-144 mm Hg] and systolic blood pressure group-5 [(144.8±4.3), range ≥145 mm Hg]; diastolic pressure group-1 [(56.5±3.5), range≤61 mm Hg], diastolic pressure group-2 [(64.8±1.8), range 62-66 mm Hg], diastolic pressure group-3 [(68.7±1.9), range 67-73 mm Hg], diastolic pressure group-4 [(75.2±2.2), range 74-79 mm Hg] and diastolic pressure group-5 [(84.6±4.7), range 80-90 mm Hg]. The clinical characteristics of each group were compared. Multivariate Cox risk model was used to predict the independent factors of MACCE. Results Body mass index and heart rate at admission in systolic blood pressure group-1 and diastolic blood pressure group-1 were lower than those in the other four groups(P<0.05). The proportion of hypertension in systolic blood pressure group-5 and diastolic blood pressure group-5 were higher than that in the other four groups(P<0.05). High density lipoprotein cholesterol(HDL-C) levels in systolic blood pressure group-1 and diastolic blood pressure group-1 were higher than those in the other four groups(P<0.05). The proportion of angiotensin converting enzyme inhibitors(ACEI) or angiotensin receptor blockers(ARB) used in systolic and diastolic blood pressure group-1 were lower than that in the other four groups(P<0.05). Multivariate Cox risk regression showed that systolic blood pressure ≤104 mm Hg(HR 2.052), systolic blood pressure ≥145 mm Hg(HR 2.205), diastolic blood pressure ≤61 mm Hg(HR 1.359), diastolic blood pressure ≥80 mm Hg(HR 1.490), age(HR 3.325) and Killip classification(3/4)(HR 11.687) were independent risk factors for the occurrence of MACCE. The use of ACEI or ARB(HR 0.204) was an independent protective factor for the occurrence of MACCE in patients with AMI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE was "U" shaped. Conclusion Systolic blood pressure(≤104 or ≥145 mm Hg), diastolic blood pressure(≤61 or ≥80 mm Hg) before PCI in patients with AMI may be independent risk factors for MACCE after PCI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE is "U" shaped.
Objective To investigate the relationship between systolic/diastolic blood pressure before percutaneous coronary intervention(PCI) and major adverse cardio-cerebrovascular events(MACCE) in patients with acute myocardial infarction(AMI). Methods Five hundred and eighty two patients with AMI treated by PCI from January 2015 to January 2016 were selected. According to the level of systolic and diastolic blood pressure, they were sorted separately and divided into five groups by 5-quartile: systolic blood pressure group-1 [(94.4±5.6), range ≤104 mm Hg], systolic blood pressure group-2 [(107.7±3.6), range 105-111 mm Hg], systolic blood pressure group-3 [(115.6±3.5), range 112-121 mm Hg], systolic blood pressure group-4 [(138.5±3.0), range 122-144 mm Hg] and systolic blood pressure group-5 [(144.8±4.3), range ≥145 mm Hg]; diastolic pressure group-1 [(56.5±3.5), range≤61 mm Hg], diastolic pressure group-2 [(64.8±1.8), range 62-66 mm Hg], diastolic pressure group-3 [(68.7±1.9), range 67-73 mm Hg], diastolic pressure group-4 [(75.2±2.2), range 74-79 mm Hg] and diastolic pressure group-5 [(84.6±4.7), range 80-90 mm Hg]. The clinical characteristics of each group were compared. Multivariate Cox risk model was used to predict the independent factors of MACCE. Results Body mass index and heart rate at admission in systolic blood pressure group-1 and diastolic blood pressure group-1 were lower than those in the other four groups(P<0.05). The proportion of hypertension in systolic blood pressure group-5 and diastolic blood pressure group-5 were higher than that in the other four groups(P<0.05). High density lipoprotein cholesterol(HDL-C) levels in systolic blood pressure group-1 and diastolic blood pressure group-1 were higher than those in the other four groups(P<0.05). The proportion of angiotensin converting enzyme inhibitors(ACEI) or angiotensin receptor blockers(ARB) used in systolic and diastolic blood pressure group-1 were lower than that in the other four groups(P<0.05). Multivariate Cox risk regression showed that systolic blood pressure ≤104 mm Hg(HR 2.052), systolic blood pressure ≥145 mm Hg(HR 2.205), diastolic blood pressure ≤61 mm Hg(HR 1.359), diastolic blood pressure ≥80 mm Hg(HR 1.490), age(HR 3.325) and Killip classification(3/4)(HR 11.687) were independent risk factors for the occurrence of MACCE. The use of ACEI or ARB(HR 0.204) was an independent protective factor for the occurrence of MACCE in patients with AMI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE was "U" shaped. Conclusion Systolic blood pressure(≤104 or ≥145 mm Hg), diastolic blood pressure(≤61 or ≥80 mm Hg) before PCI in patients with AMI may be independent risk factors for MACCE after PCI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE is "U" shaped.
引文
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[9] 米亚非,薛迎生,江建军,等.2001年至2011年台州医院急性心肌梗死数据的回顾性分析[J].中华老年心脑血管病杂志,2016,18(4):367-371.
[10] 杨源,Peters B,Demaria AN.血压变化对心肌超声造影评定冠状动脉储备的影响[J].中华超声影像学杂志,2003,12(10):620-622.
[11] Lin GM,Yano Y.The role of mean blood pressure at admission in patients undergoing primary percutaneous soronary intervention[J].Int Heart J,2016,5(5):1-2.
[12] Denardo SJ,Messerli FH,Gaxiola E,et al.Coronary revascularization strategy and outcomes according to blood pressure [from the international verapamil SR-trandolapril study (INVEST)][J].J Am Coll Cardiol,2010,106(4):498-503.
[13] Dorresteijn JAN,Vand GY,Spiering W,et al.Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease:J-curve revisited[J].Hypertension,2012,59(1):14-21.
[14] Shiraishi J,Kohno Y,Sawada T,et al.Systolic blood pressure at admission,clinical manifestations,and in-hospital outcomes in patients with acute myocardial infarction[J].J Am Coll Cardiol,2011,58(1):54-60.
[15] Wright JT,Williamson JD,Whelton PK,et al.A Randomized trial of intensive versus standard blood-pressure control[J].New Engl J Med,2016,42(8):141-143.
[16] 蒋鹤,李声娜,朱苏徽,等.急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后出院死亡调查[J].中国动脉硬化杂志,2016,24(4):409-412.
[17] 孙佳艺,张倩,赵冬,等.北京市2007-2012年急性心肌梗死住院患者30天病死率变化趋势分析[J].中华流行病学杂志,2018,39(3):363-367.
[18] 陈冬生,栾献亭,杨进刚,等.中国急性心肌梗死不同Killip分级患者的临床特征、治疗和预后情况分析[J].中国循环杂志,2016,31(9):849-853.
[19] 马丽娜,莫鹏,党晓红,等.急性冠脉综合征患者入院时心率对住院期间全因死亡的预测价值[J].中国老年学杂志,2015,35(19):5479-5482.
[20] 袁霄,王瑞钰,沈健,等.体质量指数与急性ST段抬高型心肌梗死患者预后的相关性研究[J].重庆医学,2017,46(27):3782-3785.
[2] Palmerini T,Biondi-Zoccai G,Riva DD,et al.Stent thrombosis with drug-eluting and bare-metal stents:evidence from a comprehensive network meta-analysis[J].Lancet,2012,379(9824):1393-1402.
[3] Pitsavos C,Panagiotakos D,Zombolos S,et al.Systolic blood pressure on admission predicts in-hospital mortality among patients presenting with acute coronary syndromes:the Greek study of acute coronary syndromes[J].J Clin Hypertens,2010,10(5):362-366.
[4] Park H,Hong YJ,Cho JY,et al.Blood pressure target and clinical outcome in patients with acute myocardial infarction[J].Korean Circ J,2017,47(4):446-454.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[6] Wright RS,Anderson JL,Adams CD,et al.2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline):a report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines[J].Circulation,2011,123(18):2022-2060.
[7] 樊晓寒,孙凯,周宪梁,等.中老年高血压患者体位性高血压和体位性低血压与靶器官损害关系分析[J].中华高血压杂志,2011,19(3):220-224.
[8] Rosendorff C,Lackland DT,Allison M,et al.Treatment of hypertension in patients with coronary artery disease:a scientific statement from the American Heart Association,American College of Cardiology,and American Society of Hypertension[J].Circulation,2015,131(19):435-470.
[9] 米亚非,薛迎生,江建军,等.2001年至2011年台州医院急性心肌梗死数据的回顾性分析[J].中华老年心脑血管病杂志,2016,18(4):367-371.
[10] 杨源,Peters B,Demaria AN.血压变化对心肌超声造影评定冠状动脉储备的影响[J].中华超声影像学杂志,2003,12(10):620-622.
[11] Lin GM,Yano Y.The role of mean blood pressure at admission in patients undergoing primary percutaneous soronary intervention[J].Int Heart J,2016,5(5):1-2.
[12] Denardo SJ,Messerli FH,Gaxiola E,et al.Coronary revascularization strategy and outcomes according to blood pressure [from the international verapamil SR-trandolapril study (INVEST)][J].J Am Coll Cardiol,2010,106(4):498-503.
[13] Dorresteijn JAN,Vand GY,Spiering W,et al.Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease:J-curve revisited[J].Hypertension,2012,59(1):14-21.
[14] Shiraishi J,Kohno Y,Sawada T,et al.Systolic blood pressure at admission,clinical manifestations,and in-hospital outcomes in patients with acute myocardial infarction[J].J Am Coll Cardiol,2011,58(1):54-60.
[15] Wright JT,Williamson JD,Whelton PK,et al.A Randomized trial of intensive versus standard blood-pressure control[J].New Engl J Med,2016,42(8):141-143.
[16] 蒋鹤,李声娜,朱苏徽,等.急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后出院死亡调查[J].中国动脉硬化杂志,2016,24(4):409-412.
[17] 孙佳艺,张倩,赵冬,等.北京市2007-2012年急性心肌梗死住院患者30天病死率变化趋势分析[J].中华流行病学杂志,2018,39(3):363-367.
[18] 陈冬生,栾献亭,杨进刚,等.中国急性心肌梗死不同Killip分级患者的临床特征、治疗和预后情况分析[J].中国循环杂志,2016,31(9):849-853.
[19] 马丽娜,莫鹏,党晓红,等.急性冠脉综合征患者入院时心率对住院期间全因死亡的预测价值[J].中国老年学杂志,2015,35(19):5479-5482.
[20] 袁霄,王瑞钰,沈健,等.体质量指数与急性ST段抬高型心肌梗死患者预后的相关性研究[J].重庆医学,2017,46(27):3782-3785.