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背景脑卒中是急性心肌梗塞的一个重要并发症,但有关急性冠脉综合症(acutecoronarysyndrome,ACS)患者中脑卒中的发生率和结局的报道很少。本研究探讨了ACS患者发生出血性和非出血性脑卒中的危险因素。方法和结果研究对象为急性冠脉事件全球性登记研究(GlobalRegistry0fAcuteCoronaryEvents,GRACE)入选的35,233名ACS患者。住院期间发生脑卒中310冽(0.9%),其中100例死亡(占32.6%)。ST段抬高的心肌梗塞患者住院期间的脑卒中发生率显著高于非ST段抬高的心肌梗塞患者以及不稳定型心绞痛(分别为1.3%,0.9%,0.5%;P<0.001)。有35.50A,的脑卒中发生在入院6天内。增加住院期间非出血性卒中的最重要危险因素是冠脉搭桥术(CABG),其次是住院期间发生房颤、脑卒中史、谷草转氨酶和高龄。服用他汀类药物是一个保护因素。校正混杂因素后,脑卒中显著增加ACS患者的住院死亡率达8.3倍(95%可信区间:6.0-11.4)。出院后的ACS患者发生脑卒中者有269例(占1.1%),其中56例死亡(占20.9%)。住院期间发生过脑卒中是增加出院后脑卒中的最重要危险因素。结论脑卒中在ACS患者中的发生率并不高,但有很高的死亡率。出院后脑卒中的发生率也较高,因此有待采取新措施以降低ACS患者发生脑卒中的危险。简介:GRACE研究-GlobalRegistryofAcuteCoronaryEvents,急性冠脉事件全球性登记研究,是一项国际多中心针对ACS患者进行的登记研究,随访6个月。研究设计为非随机化的观察性研究,研究者为FoxKAA,GoodmanSG,KleinW,etal.GRACE研究主要研究急性冠脉综合征的对策,不同治疗措施及其临床后果的差异,为急性冠脉综合征患者提供充分有力的人群水平的治疗资料。
Background Stroke is an important complication of acute myocardial infarction, but there are few reports on the incidence and outcome of stroke in patients with acute coronary syndrome (ACS). This study explored the risk factors for hemorrhagic and non-hemorrhagic strokes in ACS patients. Methods and Results Subjects were 35,233 ACS patients enrolled in the Global Registry for Cerebrovascular Events (GRACE). Stroke occurred 310 冽 (0.9%) during hospitalization, with 100 deaths (32.6%). ST-segment elevation myocardial infarction was associated with a higher incidence of stroke during hospitalization in patients with non-ST elevation myocardial infarction and unstable angina (1.3%, 0.9%, 0.5%; P <0.001, respectively). Stroke with 35.50A occurred within 6 days of admission. The most important risk factor for increased non-hemorrhagic stroke during hospitalization was coronary artery bypass surgery (CABG), followed by atrial fibrillation, stroke history, aspartate aminotransferase, and advanced age during hospitalization. Taking statins is a protective factor. After the confounding factors were corrected, stroke significantly increased hospital mortality in patients with ACS 8.3 times (95% CI: 6.0-11.4). Among discharged ACS patients, 269 (1.1%) had stroke and 56 died (20.9%). Stroke during hospitalization is the most important risk factor for increasing post-hospital stroke. Conclusion Stroke incidence in ACS patients is not high, but there is a high mortality rate. The incidence of stroke after discharge is also high, so new measures need to be taken to reduce the risk of stroke in ACS patients. INTRODUCTION: The GRACE Study - GlobalRegistryofAcuteCoronaryEvents, Global Registry of Acute Coronary Events, is an international multicentre registry study of patients with ACS for 6 months. The study was designed as a nonrandomized observational study of FoxKAA, GoodmanSG, KleinW, etal.GRACE study of the main research strategies of acute coronary syndromes, different treatment measures and their clinical consequences of differences for the acute coronary syndrome Patients provide sufficient vigorous crowd-level treatment information.