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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年06期

页码:

641-646

栏目:

临床医学

出版日期:

2023-11-20

文章信息/Info

Title:

Relationship between nocturnal heart rate patterns and long-term prognosis of STEMI patients after PCI

文章编号:

1006-8147(2023) 06-0641-06

作者:

吴宁¹; 赵珺¹; 董福强¹; 刘彤¹; 郑杨²

（1.天津医科大学第二医院心脏内科，天津300211; 2.吉林大学第一医院心血管内科，长春130061）

Author(s):

WU Ning¹; ZHAO Jun¹; DONG Fu-qiang¹; LIU Tong¹; ZHENG Yang²

（1. Department of Cardiology，The Second Hospital of Tianjin Medical University，Tianjin 300061，China; 2.Department of Cardiology，The First Hospital of Jilin University，Changchun 130061，China）

关键词:

急性ST抬高型心肌梗死; 经皮冠状动脉介入; 夜间心率模式

Keywords:

acute ST elevation myocardial infarction; percutaneous coronary intervention; nocturnal heart rate pattern

分类号:

R541.4

DOI:

-

文献标志码:

A

摘要:

目的：探索急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）治疗后夜间心率模式与远期预后的关系。方法：根据心电监护心率记录，将入组的STEMI患者（1 166例）分为3组，即勺型心率组（A组100例）、非勺型心率组（B组821例）、反勺型心率组（C组245例），探讨3种夜间心率模式对主要心血管不良事件（MACE）及全因死亡的影响，并比较多种心率指标的预后预测价值。结果：与A组相比，B、C组年龄较大（K-W值：7.530，P<0.05），A、B、C组对比，睡眠平均心率依次升高（K-W值：86.596，P<0.05）；MACE发生率依次增高，分别为4.5%、15.4%、26%（χ2=29.078，P<0.05）；全因死亡发生率依次增高，分别为1.3%、4.8%、7.7%（χ2=7.672，P<0.005）。Kaplan-Meier生存曲线分析显示，在MACE中，A、B、C组累积生存率依次降低（Log-Rank<0.001），在Cox回归分析中，调整年龄、性别及心血管传统危险因素后，睡眠平均心率增加（HR=1.022，95%CI：1.011～1.034，P<0.001）、非勺型（HR=3.198，95%CI：1.49～6.867，P=0.003）及反勺型（HR=4.663，95%CI：2.068～10.518，P<0.001）心率与MACE发生风险增加相关，睡眠心率增加（HR=1.057，95%CI：1.038～1.077，P<0.001）与全因死亡风险增加相关。纳入病变血管数量、Killip分级、用药因素等指标时，只有非勺型及反勺型心率模式与MACE风险增加相关，而全因死亡风险增加始终只与睡眠平均心率增加相关。结论：睡眠平均心率和夜间心率模式可能具有更强的预后预测价值，有助于早期识别高危风险人群。

Abstract:

Objective：To explore the relationship between nocturnal heart rate patterns and long-term prognosis in patients with acute ST-segment elevation myocardial infarction（STEMI） undergoing percutaneous coronary intervention（PCI）. Methods：According to the heart rate recorded by ECG monitoring，the enrolled patients with STEMI（n=1 166） were divided into three groups：dipper heart rate group（group A，n=100），non-dipper heart rate group（group B，n=821），and reverse dipper heart rate group （group C，n=245）. The effects of three nocturnal heart rate patterns on major adverse cardiovascular events（MACE） and all-cause mortality were investigated，and the prognostic value of multiple heart rate indicators was compared. Results：Compared with group A，group B and C were older（K-W value：7.530，P<0.05）. The sleep average heart rate （K-W value：86.596，P<0.05），incidence of MACE（4.5%，15.4%，26%）（χ2=29.078，P<0.05）and all-cause mortality（1.3%，4.8%，7.7%）（χ2=7.672，P<0.005）in group A，B，and C were increased in turn. Kaplan-Meier survival curve analysis showed that the cumulative survival rate of MACE events in group A，B and C decreased in turn（Log-Rank<0.001）. In Cox regression analysis，after adjusting for age，gender and traditional cardiovascular risk factors，sleep average heart rate increased （HR=1.022，95%CI：1.011-1.034，P<0.001），non-dipper （HR=3.198，95%CI：1.49-6.867，P=0.003），and reverse dipper （HR=4.663，95% CI：2.068-10.518，P<0.001） was associated with an increased risk of MACE，while increased sleep heart rate was associated with increased risk for all-cause mortality（HR=1.057，95%CI：1.038-1.077，P<0.001）. When the number of involved vessels，Killip classification，medication factors and other indicators were included，only the non-dipper and reverse dipper heart rate patterns were associated with an increased risk of MACE，while the increased risk of all-cause mortality was always only associated with an increased sleep average heart rate. Conclusion：Sleep average heart rate and nocturnal heart rate patterns may be more valuable in predicting prognosis，and may be helpful for early identification of high-risk population.

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相似文献/References:

备注/Memo

备注/Memo:

基金项目 天津医科大学第二医院重点实验室项目（2019ZDSYS09）
作者简介 吴宁（1995-），女，医师，硕士，研究方向：冠心病、肿瘤心脏病学的临床及基础研究；通信作者：郑杨，E-mail：zhengyanghappy07@sina.com。

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更新日期/Last Update: 2023-12-01