中国循证医学杂志

中国循证医学杂志

天津市急性冠脉综合征患者二级预防期间临床预后分析

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目的 评估天津市急性冠脉综合征(ACS)患者的临床预后并探究其影响因素。 方法 使用天津市城镇职工基本医疗保险数据库,纳入 2012 年至 2014 年期间有≥1 次以 ACS 为主要出院诊断且无恶性肿瘤的患者。回顾性分析患者首次 ACS 出院后 12 个月期间是否发生不良心血管事件(MACE)(包括心梗、卒中、死亡及其复合终点),评估患者的临床预后,采用 Cox 比例风险模型探究二级预防期间预后的影响因素。 结果 共纳入 22 041 例 ACS 患者,出院后 12 个月内,3.1% 的 ACE 患者发生心梗,5.7% 发生卒中,1.4% 发生死亡,共计 9.5% 的患者发生 MACE,平均发生 1.3 次。首次 MACE 平均发生在出院后 143.2 天。高龄、男性、察尔森合并症指数(CCI)得分较高、基线有过卒中或全因住院的患者更易发生 MACE;基线有过心绞痛、用过 β 受体阻滞剂或入组住院时接受经皮冠状动脉介入手术的患者更不易发生 MACE。 结论 天津市 ACS 患者中,MACE 高发类型为卒中,高发时间为 ACS 出院后三个月;高龄、男性、较高 CCI 得分及基线卒中史是影响预后的危险因素。

Objectives To evaluate the clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin city. Methods Data were obtained from Tianjin urban employee basic medical insurance database. Adult patients who were discharged alive after the first ACS-related hospitalization (the index hospitalization) during January, 2012 to December, 2014 and without malignant tumor were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause death, or their composite endpoint. Cox model was used to explore the factors associated with MACE. Results 22 041 patients were identified, in which 9.5% experienced MACE during follow-up with a mean number of 1.3 MACEs. 3.1% of patients had MI, 5.7% had stroke and 1.4% had all-cause death. Among patients who experienced MACEs, the average time from index discharge to the 1st MACE was 143.2 days. Patients being older, male or had higher Charlson Comorbidity Index (CCI) were more likely to experience MACE. Patients who had prior stroke and prior all-cause hospitalization were also more likely to experience MACE, whereas patients who had prior angina, prior β-blockers utilization and received percutaneous coronary intervention (PCI) during index event were less likely to experience MACE. Conclusion Stroke is the most common type of MACE among ACS patients in Tianjin, China. Almost half of the 1st MACE occur within the 3 months after ACS. Patients who are older, male, have higher CCI or have prior stroke are at higher risk of MACE.

关键词: 急性冠脉综合征; 预后; 不良心血管事件; 卒中; 心肌梗死; 天津; 城镇职工; 基本医疗保险数据库; 真实世界研究

Key words: Acute coronary syndromes; Outcome; Major adverse cardiovascular events; Stroke; Myocardial infarction; Tianjin; Arban employee; Basic medical insurance database; Real world study

引用本文: 刘鑫, 贺小宁, 吴晶. 天津市急性冠脉综合征患者二级预防期间临床预后分析. 中国循证医学杂志, 2018, 18(11): 1232-1238. doi: 10.7507/1672-2531.201807137 复制

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