静息心率对冠心病患者血管重建后死亡率的影响Prognostic value of resting heart rate in patients with coronary heart disease after revascularization
刘小慧,康俊萍,吕强,杜昕,聂少平,胡荣,刘新民,陈顺华,董建增,马长生
摘要(Abstract)：
目的了解静息心率对冠心病患者血管重建死亡率的影响。方法DESIRE-plus(Drug-Eluting Stent Impact on Revascularization plus)为单中心回顾性注册研究,入选2004年7月1日至2005年9月30日在我院接受血管重建治疗(PCI和CABG)的冠心病患者3 632例,根据入院时静息心率(RHR)分为RHR<70次/min、70~79次/min、80~89次/min和≥90次/min四组。记录患者临床特点、住院和随访期间死亡率。冠心病二级预防药物治疗包括阿司匹林(ASA)、β受体阻滞剂(BB)、他汀类药物和血管紧张素转换酶抑制剂(ACEI)。结果完成随访,并且资料完整的3 631例患者进入最终分析(其中RHR<70次/min者1 296例、RHR 70~79次/min者1407例、RHR 80~89次/min者721例,RHR≥90次/min者207例)。中位数随访时间为555d(7~879d)。住院死亡31例(0.9%),随访死亡59例(1.8%)。与其他组比较,RHR≥90次/min组的患者多合并高血压、糖尿病、多支血管病变及较高的总胆固醇水平,并且心肌梗死发生率高于其他组。该组患者BB药物使用剂量明显高与其他组。住院期间死亡率:RHR<70次/min组为0.5%;RHR>90次/min组为1.9%(P=0.03)。随访中死亡率:RHR<70次/min组为1.1%;RHR≥90次/min组为5.3%(P=0.003)。将相关危险因素放入Cox回归分析,校正了其他心血管危险因素后,结果显示静息心率是影响患者住院和随访期间死亡率的独立危险因素。随着心率增快死亡率增加:RHR 70~79次/min,危险比(HR)为1.59(95%CI0.89~2.86);RHR 80~89次/min,HR=1.78(95%CI0.94~3.39);RHR≥90次/min,HR=3.14(95%CI1.52~6.49)。与RHR<70次/min比,RHR≥80次/min死亡风险增加(HR=1.78,95%CI0.94~3.39),RHR≥90次/min死亡风险增加更显著(HR=3.14,P=0.002)。结论静息心率是冠心病患者血管重建后的预测因素,静息RHR≥90次/min患者死亡发生率高,应对心率快的患者强化BB治疗。
关键词(KeyWords)： 心率;冠状动脉疾病;心肌血管重建术;危险因素;预后
基金项目(Foundation):
作者(Author): 刘小慧,康俊萍,吕强,杜昕,聂少平,胡荣,刘新民,陈顺华,董建增,马长生
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