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目的分析窦性心率震荡现象(HRT)对急性冠脉综合征(ACS)患者预后的影响。方法自2005年9月—2007年12月因ACS入住某医院的患者共352例,其中入院2～3周内在24h动态心电图中发现室性早搏、并且室性早搏前至少有3个窦性心搏、室性早搏后至少有20个窦性心搏的患者共309例。通过测量室性早搏前后RR间期来测量HRT,同时收集其他影响ACS预后的相关指标如年龄、性别、吸烟、高血压、糖尿病、血脂异常、家族史、高尿酸血症、ACS类型、治疗方法、用药情况等。HRT根据震荡初始(TO)和震荡斜率(TS)的值分为正常(TO<0ms/RRI且TS>2.5ms/RRI)和异常(TO≥0ms/RRI或TS≤2.5ms/RRI)。随访时间为2a,一级终点为死亡,次级终点为需住院治疗的再发心血管事件(包括心力衰竭、再发ACS以及严重的心律失常)。结果309例ACS患者中男性190例,年龄(62.3±11.5)岁;女性119例,年龄(64.5±16.2)岁,平均随访(21.3±12.2)个月,死亡40例,次级终点84例。Logistic多元回归分析显示,死亡危险因素包括HRT异常及急性心肌梗死,其相关危险系数分别为48.69和34.92。非致死性心脏事件危险因素主要是HRT异常,其相关危险系数为12.86。结论HRT的异常提示ACS患者死亡及非致死性心脏事件的风险增加,HRT可能是评估ACS预后的可靠指标之一。
Objective To analyze the effect of sinus rhythm of heart rate (HRT) on the prognosis of patients with acute coronary syndrome (ACS). Methods A total of 352 patients admitted to a hospital from September 2005 to December 2007 were enrolled in this study. Among them, premature ventricular contractions were found in 24h ambulatory electrocardiogram within 2 to 3 weeks after admission and at least 3 sinus beats before ventricular premature beat, There were 309 patients with at least 20 sinus beats after ventricular premature beat. HRT was measured by measuring the RR interval before and after premature ventricular contractions and other relevant indicators influencing the prognosis of ACS such as age, gender, smoking, hypertension, diabetes, dyslipidemia, family history, hyperuricemia, type of ACS, treatment , Medication and so on. The HRT is classified as normal (TO <0ms / RRI with TS> 2.5ms / RRI) and abnormal (TO≥0ms / RRI or TS≤2.5ms / RRI) based on the values of Oscillation Initial (TO) and Oscillation Slope (TS). Follow-up was performed for 2 years, with a primary endpoint of death and a secondary endpoint of recurrent cardiovascular events requiring hospitalization (including heart failure, recurrent ACS, and severe arrhythmias). Results Among 309 ACS patients, 190 were male (62.3 ± 11.5) years old and 119 were female (64.5 ± 16.2) years old, with an average follow-up of (21.3 ± 12.2) months, 40 deaths and 84 secondary follow-up. Logistic multivariate regression analysis showed that risk factors for death included HRT abnormalities and acute myocardial infarction, with associated risk factors of 48.69 and 34.92, respectively. The risk factors for non-fatal cardiac events were mainly HRT abnormalities with a correlation risk coefficient of 12.86. Conclusion The abnormality of HRT suggests that the risk of death and non-fatal cardiac events in patients with ACS increase. HRT may be one of the reliable indicators to evaluate the prognosis of ACS.