JAHA:ST段抬高心肌梗死患者卒中的发生率和长期结局

2021-11-29 MedSci原创 MedSci原创

在出现STEMI的患者中,卒中的风险很低(0.76%)。出现STEMI的患者卒中与显著较高的院内死亡率(18%)和长期死亡率(5年时为35%)相关。卒中与5年死亡风险增加一倍相关。

大多数ST段抬高型心肌梗死(STEMI)患者接受心导管术和经皮冠状动脉介入术(PPCI)。在过去的几十年中,与经皮冠状动脉介入治疗(PCI)相关的许多并发症有所减少,但与PCI相关的卒中并未减少。PCI相关卒中的历史发病率在所有PCI手术中的比例为0.22%至1.3%。目前关于ST段抬高型心肌梗死(STEMI)患者卒中的真实世界研究数据很少。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员旨在评估2003年至2019年期间4个大型区域性STEMI项目中卒中的发生率、趋势、原因和预测因素。研究人员还评估了卒中对患者5年死亡率的长期影响。研究人员通过采用多变量Logistic和Cox回归分析明确了与STEMI患者卒中独立相关的变量,并确定了与5年死亡率相关的变量。

研究期间共有12868名患者出现了STEMI。98名(0.76%)患者发生了卒中。随着时间的推移,卒中的发生率保持稳定(2003年为0.5%,2019年为1.2%;趋势P=0.22)。大多数(75%)卒中为缺血性卒中,初次经皮冠状动脉介入治疗后出现卒中症状的中位时间为14小时(四分位距为4-72小时),这导致少数(3%)接受血管内治疗和高住院死亡率(18%)。

在多元回归分析中,年龄(增加10岁)(比值比[OR]为1.32;95%CI为1.10-1.58;P值=0.003)和干预前心源性休克(OR为2.03;(95%CI为1.03-3.78;P=0.032))与较高的院内卒中风险相关。院内卒中与5年死亡率增加的风险独立相关(风险比为2.01;95%CI为1.13-3.57;P=0.02)。

由此可见,在出现STEMI的患者中,卒中的风险很低(0.76%)。出现STEMI的患者卒中与显著较高的院内死亡率(18%)和长期死亡率(5年时为35%)相关。卒中与5年死亡风险增加一倍相关。

原始出处:

Michael Megaly,et al.Incidence and Long‐Term Outcomes of Stroke in Patients Presenting With ST‐Segment Elevation–Myocardial Infarction: Insights From the Midwest STEMI Consortium.JAHA.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.121.022489

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    2021-12-01 zhaohui6731
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    2021-12-01 gdsun
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    2021-12-01 hyf035

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