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目的探讨贫血对置入支架的急性冠脉综合征(ACS)合并心房颤动(AF)患者病情及预后的影响。方法通过检索电子病历库,选取2010-01-01至2015-01-31在首都医科大学附属北京安贞医院、中国医学科学院阜外医院、中国人民解放军总医院、中国人民解放军海军总医院等北京市12家医院置入支架的ACS合并AF患者3 156例进行多中心的回顾性研究,根据血红蛋白分为贫血组(n=865)和非贫血组(n=2 291)。收集两组患者的一般资料,包括基本信息、既往史、实验室检查、心功能超声检查;根据统一的评分标准分别进行GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分;随访截止至2016-03-20,记录主要不良心脑血管事件(MACCEs)和出血事件发生情况。结果两组年龄、住院天数、身高、体质量、体质指数(BMI)、舒张压、白细胞计数、血细胞比容、红细胞体积分布宽度、血肌酐(SCr)、血尿素(BUN)、血尿酸(SUA)、血清蛋白(ALB)、内生肌酐清除率(CCr)、凝血酶原活动度比较,差异有统计学意义(P<0.05);两组心率、收缩压、红细胞计数、空腹血糖(FPG)、血钾、左心室射血分数(LVEF)、国际标准化比值(INR)比较,差异无统计学意义(P>0.05)。两组性别、吸烟史、饮酒史、高血压史、糖尿病史、卒中史、既往血管病史、心功能不全发生率、肾功能不全发生率、便隐血阳性率、起搏器植入史、Killip分级、纽约心脏病协会(NYHA)分级、ACS类型、AF类型比较,差异有统计学意义(P<0.05);两组既往经皮冠状动脉介入(PCI)史、冠心病史、冠心病家族史、肝功能不全发生率、高尿酸血症发生率比较,差异无统计学意义(P>0.05)。两组GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分比较,差异均有统计学意义(P<0.05)。两组MACCEs发生率、全因死亡率比较,差异有统计学意义(P<0.05);两组非致死性心肌梗死发生率、非致死性卒中发生率、靶血管重建率比较,差异无统计学意义(P>0.05)。两组大出血率、小出血率比较,差异有统计学意义(P<0.05);两组大、小总出血率比较,差异无统计学意义(P>0.05)。两组MACCEs、全因死亡事件的Kaplan-Meier生存曲线比较,差异有统计学意义(P<0.05);两组非致死性心肌梗死事件、非致死性卒中事件、靶血管重建事件、出血事件的Kaplan-Meier生存曲线比较,差异无统计学意义(P>0.05)。多因素Cox比例风险回归模型分析结果显示,白细胞计数、血红蛋白、红细胞体积分布宽度、FPG、ALB、LVEF、既往PCI史、卒中史、便隐血阳性、NYHA分级是MACCEs发生的风险因素(P<0.05)。结论贫血的ACS合并AF患者有更高的MACCEs发生率和全因死亡率。贫血可作为置入支架的ACS合并AF患者MACCEs风险的预测因子。
Objective To investigate the effect of anemia on the severity and prognosis of patients with acute coronary syndrome (ACS) and atrial fibrillation (AF). Methods From January 1, 2010 to January 31, 2015, at the Beijing Anzhen Hospital Affiliated to Capital Medical University, Fuwai Hospital of Chinese Academy of Medical Sciences, General Hospital of Chinese People’s Liberation Army, Chinese PLA General Hospital, and other Beijing hospitals A multicenter retrospective review of 3,156 patients with ACS-combined AF in 12 hospitals in 12 municipalities in China was conducted and divided into anemia group (n = 865) and non-anemia group (n = 2 291) according to hemoglobin. The general data of two groups were collected, including basic information, past history, laboratory examination and cardiac function ultrasound examination. The GRACE score, CRUSADE score, HAS-BLED score, CHADS2 score and CHA2DS2-VASc score were respectively graded according to the unified evaluation criteria. Follow-up to 2016-03-20, recorded the main adverse cardiovascular events (MACCEs) and bleeding events. Results The results of age, length of hospital stay, height, body mass, body mass index (BMI), diastolic blood pressure, white blood cell count, hematocrit, width of erythrocyte volume distribution, serum creatinine (SCr), blood urea nitrogen (P <0.05). The heart rate, systolic blood pressure, erythrocyte count, fasting blood glucose (FPG) and total cholesterol in the two groups were significantly higher than those in the control group , Serum potassium, left ventricular ejection fraction (LVEF), international standardization ratio (INR), the difference was not statistically significant (P> 0.05). Two groups of sex, smoking history, drinking history, history of hypertension, history of diabetes, history of stroke, previous history of vascular disease, heart failure, incidence of renal insufficiency, occult blood positive rate, pacemaker implantation history, Killip grading , New York Heart Association (NYHA) grading, ACS type and AF type, the difference was statistically significant (P <0.05). The two groups had no significant difference in past PCI, history of coronary heart disease, family history of coronary heart disease, The incidence of liver dysfunction, the incidence of hyperuricemia, the difference was not statistically significant (P> 0.05). There was significant difference between the two groups in GRACE score, CRUSADE score, HAS-BLED score, CHADS2 score and CHA2DS2-VASc score (P <0.05). The incidence of MACCEs and all-cause mortality in the two groups were significantly different (P <0.05). There was no significant difference between the two groups in the incidence of non-fatal myocardial infarction, non-fatal stroke and target vessel reconstruction Significance (P> 0.05). There was no significant difference between the two groups in the rate of major hemorrhage and the rate of minor hemorrhage (P <0.05). There was no significant difference in the total hemorrhage rate between the two groups (P> 0.05). There were significant differences in Kaplan-Meier survival curves between MACCEs and all-cause deaths (P <0.05). There was significant difference between the two groups in non-fatal MI, non-fatal stroke, target revascularization, hemorrhage Kaplan-Meier survival curves, the difference was not statistically significant (P> 0.05). Multivariate Cox regression analysis showed that white blood cell count, hemoglobin, volume distribution of red blood cells, FPG, ALB, LVEF, previous PCI history, stroke history, occult blood test positive and NYHA classification were risk factors of MACCEs (P <0.05 ). Conclusions Anemia ACS patients with AF have a higher incidence of MACCEs and all-cause mortality. Anemia can be used as a predictor of MACCEs risk in patients with ACS undergoing stent implantation.